LGBTQ_Applicant_Data_Form_B2727768.pdf
PDF 2 MB Posted
- Attached to
- Holiday Wreaths
- Solicitation number
- B2727768
- 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 information from bidders on contracting opportunities. The form is designed 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 information regarding the applicant's LGBTQ business ownership status, current LGBTBE certification through the National LGBT Chamber of Commerce (NGLCC) via the Independence Business Alliance (IBA), any additional third-party certifications from agencies such as ESMDC, PAUCP, Disability:IN, or WBENC, and the involvement of LGBTBE-certified subcontractors on the project. The specific contracting opportunity associated with this form is a micro purchase for Holiday Wreaths to be awarded as a whole or by line item to the lowest responsive and responsible bidder, with the requirement that all items be quoted for award eligibility.
Submission of the LGBTQ Applicant Data Form is entirely voluntary, and applicants agree that the City of Philadelphia may use the submitted data for other projects and may make it publicly available at its discretion. The data collected serves to identify the number of LGBTQ-owned businesses currently conducting business with the City and assists in expanding the City's vendor database to include certified LGBTQ businesses. This micro purchase represents a firm limit purchase with no information provided regarding specific pricing, set-asides, incumbent vendors, or funding sources in the available documentation.
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Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B2727768.pdf | ||
| Seller_SP_Checklist_B2727768.pdf | ||
| MP_Terms_and_Conditions_B2727768.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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