LGBTQ_Applicant_Data_Form_B2627005.pdf
PDF 2 MB Posted
- Solicitation number
- B2627005
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department for contract opportunity B2627005, related to Eaton UPS one-time preventative maintenance services for five UPS units in Pennsylvania. The form serves as a voluntary data collection instrument designed to identify businesses beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer persons seeking to engage in business with the City. The form requests applicants to indicate whether their business is LGBTBE-certified by the National LGBT Chamber of Commerce through its Philadelphia affiliate, the Independence Business Alliance, and whether they hold certifications from other third-party agencies such as the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council. Additionally, applicants are asked to identify any LGBTBE-certified subcontractors involved in the contracting opportunity.
The City of Philadelphia intends to use the submitted data to assess the number of LGBTQ-owned businesses currently conducting business with the municipality and to facilitate the inclusion of LGBTBE-certified businesses in the City's vendor database. Responses to this form are entirely voluntary, and applicants acknowledge that the City may utilize submitted data for other projects and may make such data publicly available at its discretion. This small order 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 be eligible for award consideration.
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Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B2627005.pdf | ||
| Seller_SP_Checklist_B2627005.pdf | ||
| SOP_Terms_and_Conditions_B2627005.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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