LGBTQ_Applicant_Data_Form_B2727737.pdf
PDF 2 MB Posted
- Attached to
- Lightcast - Analyst - Local Data (Developer)
- Solicitation number
- B2727737
- 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 and inclusion information from businesses seeking to contract with the municipality. The form captures whether applicant businesses are beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether they hold current certifications as LGBTBE entities through the National LGBT Chamber of Commerce (NGLCC) or its local Philadelphia affiliate, the Independence Business Alliance (IBA). The form also inquires about additional third-party certifications from organizations such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC), and requests identification of any LGBTQ-certified subcontractors being utilized for the contracting opportunity. The specific opportunity referenced is a micro purchase for a Lightcast Analyst position focused on local data development.
The City of Philadelphia uses this data collection instrument as part of its commitment to diversity, equity, and inclusion in procurement activities. Submission of the form is entirely voluntary, and applicants consent to the City's discretionary use of submitted data for other projects and potential public disclosure. The data serves dual purposes: identifying the number of LGBTQ-owned businesses currently conducting business with the City and supporting efforts to integrate certified LGBTQ businesses into the City's vendor database. The form provides checkbox options for applicants to indicate certification status and subcontractor information, with fields for applicant name, bid or opportunity number, certifying agencies, and certification categories.
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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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