LGBTQ_Applicant_Data_Form_B2626779.pdf
PDF 2 MB Posted
- Attached to
- Dash Board Camera
- Solicitation number
- B2626779
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form used by the City of Philadelphia's Procurement Department to collect diversity and inclusion information from businesses seeking contract opportunities. The form requests applicants to provide their business name and the relevant bid or opportunity number while disclosing whether their company is beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer. The form also inquires whether the applicant's business is currently certified as an LGBTBE by the National LGBT Chamber of Commerce through the Philadelphia-based Independence Business Alliance, and whether any subcontractors involved in the contract opportunity hold such certifications. Additionally, the form requests identification of any third-party certifications held by the applicant through agencies such as the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council.
The City of Philadelphia is collecting this data to identify LGBTQ-owned businesses interested in doing business with the municipality and to facilitate the inclusion of LGBTQ-certified businesses in the City's vendor database. Response to the form is entirely voluntary, and applicants agree that the City may use the submitted data for other projects at its discretion and may make the data publicly available. This particular form is associated with a micro-purchase requirement contract opportunity for Dash Board Cameras in Pennsylvania, which will be awarded as a whole to the lowest responsive and responsible bidder. Sellers must quote all items to be eligible for award, and bidders are instructed not to deliver or provide services until notified by the department.
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Other files
| File | Type | Posted |
|---|---|---|
| MP_Terms_and_Conditions_B2626779.pdf | ||
| Seller_SOP_Checklist_B2626779.pdf | ||
| Consent_Authorization_B2626779.pdf |
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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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