LGBTQ_Applicant_Data_Form_B2627018.pdf
PDF 2 MB Posted
- Attached to
- 4 drum spill containment pallet wirh drain
- Solicitation number
- B2627018
- 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 B2627018, which pertains to the supply of four drum spill containment pallets with drain functionality in Pennsylvania. The form serves as a voluntary data collection instrument designed to identify businesses beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer and wish to conduct business with the City. The micro purchase will be awarded as a whole or by line item, whichever is in the best interest of the City, to the lowest responsive and responsible bidder, with sellers required to quote all items to be eligible for award.
The data collection initiative supports the City of Philadelphia's commitment to diversity, equity, and inclusion in procurement and will be used to identify LGBTQ businesses currently doing business with the City and to facilitate their inclusion in the City's vendor database. Applicants are asked to provide information regarding current LGBTBE certification through the National LGBT Chamber of Commerce (NGLCC) via its local Philadelphia affiliate, the Independence Business Alliance (IBA), as well as any third-party certifications from organizations including the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council. Applicants must also identify any NGLCC/IBA-certified subcontractors. The City reserves the right to use submitted data for other projects and may make it publicly available. Suppliers are instructed not to deliver or provide services until notified by the department.
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Other files
| File | Type | Posted |
|---|---|---|
| Micro Purchase Terms and Conditions B2627018.pdf | ||
| Seller_SP_Checklist.B2627018.pdf | ||
| consent_Authorization_B2627018.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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