LGBTQ_Applicant_Data_Form_B2627000.pdf
PDF 2 MB Posted
- Attached to
- Pallet Jack
- Solicitation number
- B2627000
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form from the City of Philadelphia's Procurement Department designed to collect information from bidders on LGBTQ business ownership and certification status for a Pallet Jack micro purchase opportunity in Pennsylvania. The form requests applicants to disclose whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether the business holds current LGBTQ Business Enterprise (LGBTBE) certification through the National LGBT Chamber of Commerce (NGLCC) via the Philadelphia-based Independence Business Alliance (IBA). Applicants must also identify any additional third-party certifications held, such as those from the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC), and list any LGBTBE-certified subcontractors being utilized on the project.
The micro purchase will be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder, with the requirement that sellers quote all items to remain eligible for award. The City of Philadelphia is collecting this data voluntarily to identify LGBTQ-owned businesses interested in doing business with the municipality and to facilitate inclusion of LGBTBE-certified vendors into the City's vendor database. Applicants consent to the City's discretionary use of submitted data for other projects and potential public availability of the information. No delivery or services should commence until official notification is received from the City department.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller_SP_Checklist.B2627000.pdf | ||
| Micro Purchase Terms and Conditions B2627000.pdf | ||
| consent_Authorization_B2627000.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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