LGBTQ_Applicant_Data_Form_B1801234~4.pdf
PDF 2 MB Posted
- Attached to
- Insect Repellent State and local contract opportunity
- Solicitation number
- B2627056
- Issued by
- Pennsylvania
About this file
This file is an LGBTQ Applicant Opportunity Data Form used by the City of Philadelphia to collect diversity and inclusion information from bidders on state and local contract opportunities. The form requests applicants to self-identify whether their business is beneficially owned and controlled by persons who identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ). The document specifically inquires about current certification status through the National LGBT Chamber of Commerce (NGLCC) via their local Philadelphia affiliate, the Independence Business Alliance (IBA), as well as any additional third-party certifications from agencies such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC). The form also requests information regarding any LGBTBE-certified subcontractors being utilized for the specific contracting opportunity.
The related contract opportunity is a micro purchase for insect repellent to be awarded by the City of Philadelphia to the lowest responsive and responsible bidder, with the award potentially made as a whole or by individual line items at the City's discretion. Completion of the LGBTQ applicant data form is voluntary and serves to assist the City in identifying LGBTQ-owned businesses currently conducting business with the municipality and to facilitate inclusion of LGBTQ-certified businesses in the City's vendor database. Applicants must quote all items to be eligible for award consideration, and no delivery or services are to commence until formal notification from the requesting department is received.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B1801234~6.pdf | ||
| Seller_SP_Checklist~9.pdf | ||
| MP_Terms_and_Conditions~3.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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