LGBTQ_Applicant_Data_Form_B2627177.pdf
PDF 2 MB Posted
- Attached to
- Games State and local contract opportunity
- Solicitation number
- B2627177
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department in support of municipal contracting opportunities. The form is designed to collect voluntary demographic information from applicants regarding their status as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ)-owned businesses. The City utilizes this data collection instrument to identify the number of LGBTQ-owned businesses seeking to conduct business with Philadelphia and to inform efforts to include LGBTQ-certified enterprises in the City's vendor database. The form requests information about beneficial ownership and control by LGBTQ persons, current certification status through the National LGBT Chamber of Commerce (NGLCC) and its Philadelphia affiliate, the Independence Business Alliance (IBA), and any subcontractor certifications. Additional questions address third-party certifications from entities such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, and Women's Business Enterprise National Council (WBENC).
Submission of the LGBTQ Applicant Data Form is entirely voluntary, and applicants are informed that the City may utilize the submitted data for other projects and may make the information publicly available. The form accommodates responses regarding the applicant's business name, bid or opportunity number, primary LGBTQ business owner status, current LGBTBE certification, additional third-party certifications with specification of certifying agency and certification category, and identification of any LGBTBE-certified subcontractors by business name. This data collection instrument supports the City of Philadelphia's broader commitment to diversity, equity, and inclusion in municipal procurement processes.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| MP_Terms_and_Conditions_B2627177.pdf | ||
| Consent_Authorization_B2627177.pdf | ||
| Seller_SOP_Checklist_B2627177.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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