LGBTQ Applicant Data Form B2727702.pdf
PDF 2 MB Posted
- Attached to
- Wireless Display Reciecver
- Solicitation number
- B2727702
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form related to a wireless display receiver micro purchase opportunity with the City of Pennsylvania. The form functions as a documentation tool for tracking applicant demographic information, specifically regarding LGBTQ status, in connection with the procurement process for the wireless display receiver line items. The micro purchase will be awarded as a whole or by individual line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder. Sellers must quote all items to be eligible for award consideration, and delivery or service provision should not commence until official notification is received from the department.
The form serves to collect voluntary LGBTQ identification data from applicants participating in the bidding process. This data collection mechanism supports diversity and inclusion tracking objectives within the procurement process. Pricing terms, set-aside provisions, incumbent contractor information, and other contract-specific commercial terms would be detailed in the primary solicitation documents rather than in this applicant demographic form. Bidders should reference the main wireless display receiver solicitation for comprehensive details regarding pricing structures, payment terms, contract duration, and any applicable small business or diversity-based set-asides.
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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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