LGBTQ_Applicant_Data_Form_B2627193.pdf
PDF 2 MB Posted
- Attached to
- Medical Chart Dividers
- Solicitation number
- B2627193
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form used by the City of Philadelphia's Procurement Department to collect diversity information from businesses seeking to contract with the city. The form is administered by the City of Philadelphia in coordination with certification bodies including the National LGBT Chamber of Commerce (NGLCC), the Independence Business Alliance (IBA), the Eastern Minority Supplier Development Council (ESMDC), the Pennsylvania Unified Certification Program (PAUCP), Disability:IN, and the Women's Business Enterprise National Council (WBENC). The form requests information regarding the applicant's LGBTQ business ownership and control, current LGBTQ business enterprise certification status through NGLCC/IBA, any additional third-party certifications held by the applicant, and identification of any LGBTBE-certified subcontractors involved in the specific contracting opportunity.
The form is entirely voluntary and designed to support the City's commitment to diversity, equity, and inclusion in procurement activities. Applicants must provide their business name, bid or opportunity number, and detailed responses to questions about beneficial ownership and control by LGBTQ persons, current NGLCC/IBA certification status, additional certifications from recognized diversity organizations, and the number and names of any certified LGBTBE subcontractors. The City explicitly reserves the right to use submitted data for other projects and may make the information publicly available. This data collection initiative aims to identify the current number of LGBTQ-owned businesses conducting business with the City and to facilitate the inclusion of LGBTQ-certified businesses in the City's vendor database.
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Other files
| File | Type | Posted |
|---|---|---|
| MP_Terms_and_Conditions_B2627193.pdf | ||
| Consent_Authorization_B2627193.pdf | ||
| Seller_SP_Checklist_B2627193.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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