LGBTQ_Applicant_Data_Form_B2727374.pdf
PDF 2 MB Posted
- Solicitation number
- B2727374
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department to collect diversity information from businesses seeking to contract with the municipality. The form requests applicants to self-identify whether their business is beneficially owned and controlled by individuals who identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ). Applicants are asked to indicate current LGBTBE certification status through the National LGBT Chamber of Commerce (NGLCC) via its Philadelphia affiliate, the Independence Business Alliance (IBA), and to identify any additional third-party certifications held through agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. The form also requires applicants to disclose whether any subcontractors hold LGBTBE certification and, if so, to list those certified subcontractors by business name.
The City of Philadelphia uses this voluntary data collection to identify LGBTQ-owned businesses interested in conducting business with the municipality and to inform efforts to include LGBTQ certified businesses in the City's vendor database. Applicants acknowledge that submitted data may be used by the City at its discretion for other projects and may be made publicly available. The form serves as part of the City's broader commitment to diversity, equity, and inclusion in public procurement. No specific response deadline, pricing information, or contract award terms are referenced within this data collection form itself.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller_SOP_Checklist_B2727374.pdf | ||
| Consent_Authorization_B2727374.pdf | ||
| MP_Terms_and_Conditions_B2727374.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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