LGBTQ_Applicant_Data_Form_B2627043.pdf
PDF 2 MB Posted
- Attached to
- Aquascope (Exeter) supply State and local contract opportunity
- Solicitation number
- B2627043
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department in conjunction with a small order purchase opportunity for Aquascope (Exeter) supply in Pennsylvania. The form is designed to collect voluntary demographic data from applicants regarding LGBTQ business ownership and certification status. The City utilizes this information to identify LGBTQ-owned businesses interested in conducting business with Philadelphia and to facilitate their inclusion in the City's vendor database. Applicants are asked to indicate whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and to provide current certification status if applicable.
The form requests detailed certification information, including whether the applicant holds current LGBTBE certification from the National LGBT Chamber of Commerce through its Philadelphia affiliate, the Independence Business Alliance, as well as any third-party certifications from agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. Applicants are also asked to identify any LGBTBE-certified subcontractors participating in the contract. Submission of the form is entirely voluntary, and by submitting, applicants agree that the City may use the data for other projects and may make it publicly available. The underlying procurement opportunity awards the small order purchase as a whole or by line item to the lowest responsive and responsible bidder, with sellers required to quote all items to be eligible for award.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| SOP Terms and Conditions B2627043.pdf | ||
| Seller_SOP_Checklist B2627043~1.pdf | ||
| Consent_Authorization_B2627043.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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