LGBTQ Applicant Data Form B2627263.pdf
PDF 2 MB Posted
- Attached to
- apparel, Kit items, community oureach items
- Solicitation number
- B2627263
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form used by the City of Philadelphia in Pennsylvania to collect diversity and inclusion information from bidders on state and local contract opportunities. The form serves as a voluntary data collection tool to identify companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons seeking to do business with the City. The form requests applicant information including business name, bid or opportunity number, and responses to questions regarding LGBTQ business ownership and control, current certification status through the National LGBT Chamber of Commerce (NGLCC) via its Philadelphia affiliate the Independence Business Alliance (IBA), and any additional third-party certifications from organizations such as 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 contracting opportunity. The related contract opportunity is a micro purchase for apparel, kit items, and community outreach items to be awarded to the lowest responsive and responsible bidder on a whole or line-item basis, whichever serves the City's best interest. Sellers must quote all items to be eligible for award and are instructed not to deliver or provide services until notified by the department. The data collected through this form is intended to support the City's commitment to diversity, equity, and inclusion in procurement activities and to enhance inclusion of LGBTQ-certified businesses in the City's vendor database.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Seller_SSE_ChecklistB2627263.pdf | ||
| Consent_AuthorizationB2627263.pdf | ||
| Micro Purchase Terms and Conditions B2627263.pdf | ||
| B2627263 SPEC Sheet.pdf |
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Text version
LGBTQ Applicant Opportunity Data
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’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. Response to this form is voluntary.
Applicant Name
Bid or Opportunity #
| 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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