LGBTQ_Applicant_Data_Form - B2727830.pdf
PDF 2 MB Posted
- Attached to
- MacBook, Webcams, and Surge Protector
- Solicitation number
- B2727830
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form for the City of Philadelphia's procurement process, administered through the Philadelphia Department of Procurement. The form is designed to collect voluntary demographic information from vendors interested in doing business with the City, specifically to identify companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer persons. The form requests applicant identification, bid or opportunity number, and certification status with relevant certifying bodies. This particular form is associated with a micro purchase opportunity for MacBook computers, webcams, and surge protectors, which will be awarded to the lowest responsive and responsible bidder as a whole or by line item, whichever serves the City's best interest. Prospective sellers must quote all items to be eligible for award consideration, and delivery or service provision should not commence until formal notification is received from the department.
The form collects information regarding current LGBTBE certification status through the National LGBT Chamber of Commerce (NGLCC) or its Philadelphia affiliate, the Independence Business Alliance (IBA), as well as any additional third-party certifications such as those from the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC). Applicants are also asked to identify any subcontractors certified as LGBTBE. The City of Philadelphia has indicated its commitment to diversity, equity, and inclusion in procurement and intends to use the collected data to identify LGBTQ businesses in its vendor database and potentially make such data publicly available. This is a requirements contract governed by the standard terms and conditions established by the City for such arrangements.
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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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