LGBTQ Applicant Data Form B2727875.pdf
PDF 2 MB Posted
- Attached to
- Basic Timeclock
- Solicitation number
- B2727875
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form submitted to the City of Philadelphia's Procurement Department for a Basic Timeclock micro purchase contract opportunity in Pennsylvania. The form serves as a voluntary data collection instrument designed to identify companies beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer (LGBTQ). The 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. Sellers must quote all items to be eligible for award, and no delivery or services are to commence until notification is provided by the department.
The form collects information regarding LGBTQ business certification status through the National LGBT Chamber of Commerce (NGLCC) via the Philadelphia affiliate 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 requested to identify any NGLCC/IBA-certified subcontractors. The City of Philadelphia explicitly states that submission of this form is entirely voluntary and that collected data may be used at the city's discretion for other projects and may be made publicly available. The data collection initiative supports the city's commitment to diversity, equity, and inclusion in procurement and assists in building the city's vendor database of LGBTQ-certified businesses.
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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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