LGBTQ_Applicant_Data_Form - B2627088.pdf
PDF 2 MB Posted
- Attached to
- Exercise Equipment
- Solicitation number
- B2627088
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form related to a City of Philadelphia micro purchase for exercise equipment in Pennsylvania. The form is designed to collect voluntary demographic information from applicants regarding their business ownership and certification status within the LGBTQ business community. The City of Philadelphia is seeking to identify companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer persons who wish to conduct business with the municipality. This 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. Applicants must quote all items to be eligible for award, and delivery or service provision should not commence until official notification is received from the department. This is a requirements purchase with no specific delivery timeline, site visit, or bidder conference details noted in the form.
The data collection form requests information regarding current LGBTQ Business Enterprise (LGBTBE) certification through the National LGBT Chamber of Commerce (NGLCC) via the Philadelphia-area Independence Business Alliance (IBA), as well as any additional third-party certifications from agencies such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC). Applicants are also asked to identify any subcontractors holding LGBTBE certification. The City has indicated that submitted data may be used for other projects and may become publicly available at the City's discretion. No specific pricing terms, incumbent information, or funding sources are detailed in this demographic collection document.
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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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