LGBTQ_Applicant_Data_Form B2626630.pdf
PDF 2 MB Posted
- Attached to
- NC COLL CARE X3 2026
- Solicitation number
- B2626630
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department to collect diversity, equity, and inclusion information from applicants for City contracts. The form applies to the "NC COLL CARE X3 2026" micro purchase opportunity in Pennsylvania and is designed to identify companies beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ). The form requests applicants to disclose whether their business is LGBTQ-owned and whether they hold current LGBTQ Business Enterprise (LGBTBE) certification from the National LGBT Chamber of Commerce (NGLCC) through the Philadelphia affiliate, the Independence Business Alliance (IBA).
The form also requests information regarding any additional third-party certifications held by the applicant, such as those from the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or the Women's Business Enterprise National Council (WBENC), along with certification categories such as Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Disadvantaged Small Business Enterprise (DSBE), or Disadvantaged Business Enterprise (DBE). Additionally, applicants must disclose the number and business names of any subcontractors certified as LGBTBE. Submission of the form is entirely voluntary, and the City of Philadelphia reserves the right to use the collected data for other projects and to make the data publicly available to support vendor database development and future LGBTQ business inclusion efforts.
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Text version
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 of Philadelphia’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.
By submitting this form you are agreeing that the City may, in its discretion, use the data submitted for other projects and may cause it to become publicly available.
Response to this form is entirely voluntary.
Applicant Name:
Bid or Opportunity #:
LGBTQ Applicant Opportunity DataLGBTQ Applicant Opportunity Data
CCIITTY Y OF OF PHIPHILALADDELPHELPHIIA
1401 JFJFK K BBllvvdd. . RoRooom m 117700B B - - PhPhiillaaddeellpphhiiaa, , PA PA 1199110022--11668855 www.phila.gov/procurement
| 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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