LGBTQ_Applicant_Data_Form_B2627022.pdf
PDF 2 MB Posted
- Attached to
- Refrigerator - Frigidaire 13. 9 cu ft
- Solicitation number
- B2627022
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department as part of a micro purchase opportunity for a Frigidaire refrigerator (13.9 cubic feet). The form is designed to collect diversity data from applicants regarding beneficial ownership and control by LGBTQ persons. The micro purchase will be awarded as a whole or by line item, whichever serves the City's best interests, to the lowest responsive and responsible bidder. All sellers must quote all items to be eligible for award, and no delivery or services should commence until official notification from the department.
The form requests information about LGBTQ business certification status, including whether applicants are certified as LGBTBE by the National LGBT Chamber of Commerce through the Philadelphia-based Independence Business Alliance, or by other third-party certifying agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. The form also inquires whether any subcontractors are LGBTBE-certified. The City of Philadelphia is using this voluntary data collection to identify LGBTQ-owned businesses interested in doing business with the City, to build its vendor database, and to promote diversity, equity, and inclusion in procurement. Applicants agree that submitted data may be used for other projects and potentially made publicly available at the City's discretion.
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Other files
| File | Type | Posted |
|---|---|---|
| Micro Purchase Terms and Conditions B2627022.pdf | ||
| consent_Authorization_B2627022.pdf | ||
| Seller_SP_Checklist.B2627022.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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