LGBTQ_Applicant_Data_Form_ B2627164.pdf

This is an LGBTQ Applicant Opportunity Data Form used by the City of Philadelphia in conjunction with a Telvue Care Renewal sole-source micro purchase opportunity in Pennsylvania. The form is designed to collect voluntary demographic information from applicants regarding LGBTQ business ownership and certification status. The document requests that applicants self-identify whether their business is beneficially owned and controlled by individuals who identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and inquires about current LGBTBE certification through the National LGBT Chamber of Commerce (NGLCC) via the Independence Business Alliance (IBA). Additionally, the form requests information regarding any additional third-party certifications held by the applicant, such as MBE, WBE, DSBE, or DBE designations from agencies including the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council. The form also requests identification of any LGBTBE-certified subcontractors involved in the proposed contract.

The City of Philadelphia emphasizes its commitment to diversity, equity, and inclusion through this data collection initiative, with the stated purpose of identifying LGBTQ-owned businesses conducting business with the City and facilitating their inclusion in the City's vendor database. The micro purchase for Telvue Care Renewal will be awarded as a whole or by line item, whichever serves the City's best interests, to the lowest responsive and responsible bidder. Completion of the LGBTQ Applicant Data Form is voluntary, and applicants must quote all items to be eligible for award consideration. The form does not include specific pricing terms, set-aside percentages, funding sources, or contract term details within its scope.