LGBTQ_Applicant_Data_Form B2727678.pdf
PDF 2 MB Posted
- Attached to
- CCOM Corrugated Boxes
- Solicitation number
- B2727678
- 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 metrics from businesses seeking to do business with the municipality. The form gathers information regarding applicant business ownership by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and tracks current certifications held by applicants and their subcontractors through recognized certification bodies such as the National LGBT Chamber of Commerce (NGLCC) and its local Philadelphia affiliate, the Independence Business Alliance (IBA). The form applies to the CCOM Corrugated Boxes micro purchase opportunity in Pennsylvania and requests applicants to identify any third-party certifications held through organizations including the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC), as well as to list any LGBTBE-certified subcontractors involved in the contract.
The City of Philadelphia has indicated that submission of this form is entirely voluntary and that the data collected may be used at the City's discretion for other projects and may be made publicly available as part of the City's commitment to diversity, equity, and inclusion in procurement. The micro purchase will be awarded as a whole or by line item to the lowest responsive and responsible bidder, with the requirement that sellers quote all items to be eligible for award. No delivery or services are to commence until official notification is provided by the department.
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Other files
| File | Type | Posted |
|---|---|---|
| Micro Purchase Terms and Conditions B2727678.pdf | ||
| Seller Checklist - B2727678.pdf | ||
| Consent_Authorization B2727678.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: |
File details come from the government source that posted it. Updated .