LGBTQ_Applicant_Data_Form_B2727408.pdf
PDF 2 MB Posted
- Attached to
- asphalt release agent
- Solicitation number
- B2727408
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form used by the City of Philadelphia's Procurement Department to collect demographic information from businesses seeking to contract with the city. The form is designed to identify companies beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ). Applicants are asked to indicate whether their business is certified as an LGBTBE by the National LGBT Chamber of Commerce (NGLCC) through its local Philadelphia affiliate, the Independence Business Alliance (IBA), and whether they hold additional certifications from third-party agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. The form also requests information about any LGBTQ-certified subcontractors participating in the project, requiring applicants to list all certified subconsultants by business name.
The City of Philadelphia uses the data collected through this form to track the number of LGBTQ-owned businesses doing business with the city and to expand inclusion of LGBTQ-certified enterprises in the city's vendor database. Submission of the form is entirely voluntary, and applicants grant the city discretion to use the provided data for other projects and to make it publicly available. The form is part of Philadelphia's broader commitment to diversity, equity, and inclusion in municipal procurement. This particular form is associated with a micro-purchase solicitation for asphalt release agent in Pennsylvania, which will be awarded as a whole or by line item to the lowest responsive and responsible bidder, with all items requiring quotation for award eligibility.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B2727408.pdf | ||
| Seller_SP_ Checklist_B2727408.pdf | ||
| MP_Terms_and_Conditions_B2727408.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .