LGBTQ_Applicant_Data_Form_B2727411.pdf
PDF 2 MB Posted
- Attached to
- Asphalt Extraction Solvent
- Solicitation number
- B2727411
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form created by the City of Philadelphia's Procurement Department for use in state and local contracting opportunities in Pennsylvania. The form collects voluntary demographic information from applicants to identify businesses beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons interested in doing business with the City. The form requests applicant name and bid or opportunity number, and inquires whether the applicant's business is LGBTBE-certified by the National LGBT Chamber of Commerce (NGLCC) through its local Philadelphia affiliate, the Independence Business Alliance (IBA), or by other third-party certifying agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. Additionally, the form asks applicants to identify any subcontractors certified as LGBTBE by business name.
The City of Philadelphia uses the data collected through this form to track the number of LGBTQ-owned businesses engaging with the City, to enhance diversity, equity, and inclusion in procurement activities, and to facilitate the inclusion of certified LGBTQ businesses in the City's vendor database. Applicants retain full discretion in responding to the form, as completion is entirely voluntary. The City reserves the right to use submitted data for other projects and may make the information publicly available at its discretion. This particular form is associated with a micro purchase for Asphalt Extraction Solvent, which will be awarded as a whole or by line item to the lowest responsive and responsible bidder, provided the seller quotes all items to be eligible for award.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller_SP_ Checklist_B2727411.pdf | ||
| Consent_Authorization_B2727411.pdf | ||
| MP_Terms_and_Conditions_B2727411.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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