LGBTQ_Applicant_Data_Form - B2727759.pdf
PDF 2 MB Posted
- Solicitation number
- B2727759
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department for a micro purchase opportunity (Bid Number B2727759) involving Health AMS tablecloths, push-up balls, and bubbles with logos. The form collects voluntary data from applicants to identify Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) businesses interested in conducting business with the City of Philadelphia. The form requests information regarding beneficial ownership and control by LGBTQ individuals, current LGBTQ Business Enterprise (LGBTBE) certification status through the National LGBT Chamber of Commerce (NGLCC) or its local Philadelphia affiliate, the Independence Business Alliance (IBA), and identifies any additional third-party certifications held by the applicant such as MBE, WBE, DSBE, or DBE designations through agencies including the Eastern Minority Supplier Development Council or Pennsylvania Unified Certification Program.
The data collected through this form will be used by the City to identify LGBTQ businesses currently operating with the City and to facilitate inclusion of LGBTQ certified businesses in the City's vendor database. Applicants are also required to disclose any subcontractors certified as LGBTBE by NGLCC/IBA and provide their business names. This micro purchase will be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder, with the requirement that all sellers quote all items to be eligible for award. Submission of the form constitutes agreement that the City may use the submitted data for other projects and may make it publicly available.
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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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