LGBTQ_Applicant_Data_Form_B2627180.pdf
PDF 2 MB Posted
- Attached to
- Craft Kits State and local contract opportunity
- Solicitation number
- B2627180
- 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 diversity, equity, and inclusion initiatives in municipal contracting. The form collects voluntary information from applicants regarding their status as businesses beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ). The document requests applicant identification, bid or opportunity number, and certification status through recognized certifying bodies such as the National LGBT Chamber of Commerce (NGLCC) through its Philadelphia affiliate, the Independence Business Alliance (IBA).
The form inquires whether applicants hold LGBTBE certification and whether they maintain certifications from other third-party agencies including the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or the Women's Business Enterprise National Council (WBENC), with fields to document certifying agency names and certification categories such as MBE, WBE, DSBE, or DBE. The form also requests information regarding any NGLCC/IBA-certified subcontractors involved in the contract opportunity. The City of Philadelphia explicitly states that submission of this data form is entirely voluntary and reserves the right to use submitted data for other projects and potentially make it publicly available to support efforts to include LGBTQ-certified businesses in the City's vendor database.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Seller_SOP_Checklist_B2627180.pdf | ||
| MP_Terms_and_Conditions_B2627180.pdf | ||
| Consent_Authorization_B2627180.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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