LGBTQ_Applicant_Data_Form_B1801234~28.pdf
PDF 2 MB Posted
- Attached to
- Rechargeable Flashlight
- Solicitation number
- B2728373
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Opportunity Data Form related to a Pennsylvania micro purchase opportunity for a Rechargeable Flashlight to be awarded to the lowest responsive and responsible bidder. The form is designed to collect voluntary demographic data from applicants regarding LGBTQ business ownership and certification status as part of the City's commitment to diversity, equity, and inclusion in procurement. The form requests information about whether the applicant's business is beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether the business holds current certification as an LGBTBE through the National LGBT Chamber of Commerce or its Philadelphia affiliate, the Independence Business Alliance. Sellers must quote all items to be eligible for award and should not deliver products or services until notified by the department.
The form also collects data regarding third-party certifications from other agencies such as ESMDC, PAUCP, Disability:IN, or WBENC, as well as information about any LGBTBE-certified subcontractors involved in the contract opportunity. No specific pricing terms, contract duration, site visit requirements, bidder conferences, or response deadlines are detailed in this data collection form. The primary purpose of this form is to identify LGBTQ businesses currently doing or wishing to do business with the City and to assist in efforts to include LGBTQ-certified businesses in the City's vendor database.
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Other files
| File | Type | Posted |
|---|---|---|
| MP_Terms_and_ConditionsB1801234.pdf | ||
| Seller_SP_Checklist_B1801234~23.pdf | ||
| Consent_Authorization_B1801234~30.pdf |
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Text version
LGBTQ Applicant Opportunity Data
1. Is Applicant’s business beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender or Queer?
2. Is Applicant’s business currently certified as a Lesbian, Gay, Bisexual, Transgender, Business Enterprise (LGBTBE) by the National LGBT Chamber of Commerce (NGLCC) through their local Philadelphia affiliate, the Independence Business Alliance (IBA)?
a. If yes, Applicant is currently certified by NGLCC/IBA as an LGBTBE, is Applicant's business also certified by any other third party certifying agency such as Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN or Women's Business Enterprise National Council (WBENC)?
If yes please identify the name of the certifying agency and category of certification (e.g., MBE, WBE, DSBE, DBE):
Certifying Agency Certification Category
3. For this contracting opportunity, are any of Applicant’s subcontractors certified by NGLCC/IBA? If yes, how many subcontractors are certified as LGBTBE?
Please list all by business name below.
As part of the City’s commitment to diversity, equity and inclusion in all aspects of City procurement, the City is collecting data to identify the number of companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender and Queer persons who wish to do business with the City (collectively, “LGBTQ businesses”). The data will be used to identify the number of LGBTQ businesses currently doing business with the City. It will also assist in efforts to include LGBTQ certified businesses into the City’s vendor database. Response to this form is voluntary.
Applicant Name
Bid or Opportunity #
| CertifiedLGBTEYes: Y |
| CertifiedLGBTENo: N |
| Certification: |
| LGBTQTypeYes: Y |
| LGBTQTypeNo: N |
| CertifiedNGLCCNo: N |
| CertifiedNGLCCYes: Y |
| LGBTQTypeY: Off |
| LGBTQTypeN: Off |
| CertifiedLGBTEY: Off |
| CertifiedLGBTEN: Off |
| CertifiedNGLCCY: Off |
| CertifiedNGLCCN: Off |
| Subconsultants: |
| BusinessName3: |
| BusinessName4: |
| BusinessName5: |
| Reset: |
| btnContinue: |
| CertifyingAgency: |
| BusinessName: |
| BusinessName2: |
| ApplicantName: |
| BidNumber: |
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