LGBTQ_Applicant_Data_Form B2727881.pdf
PDF 2 MB Posted
- Attached to
- Voting Machine Seals - City Commissioners Office
- Solicitation number
- B2727881
- 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 municipal contract opportunities. The form is designed to identify and track businesses beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons who seek to conduct business with the City. Specifically, the form requests information regarding whether the applicant's business is LGBTQ-owned, whether the business holds current LGBTQ Business Enterprise (LGBTBE) certification from the National LGBT Chamber of Commerce (NGLCC) through its Philadelphia affiliate, the Independence Business Alliance (IBA), and whether any subcontractors are LGBTBE-certified. The form also inquires whether the applicant holds additional third-party certifications from agencies such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC).
Submission of the LGBTQ Applicant Data Form is entirely voluntary and non-binding for bidders. The data collected will be used by the City of Philadelphia to build its vendor database, identify the prevalence of LGBTQ-owned businesses in municipal procurement, and support diversity, equity, and inclusion initiatives across City purchasing activities. The City reserves the right to use submitted data for other projects and may make the information publicly available at its discretion. Applicants must provide their business name, bid or opportunity number, and certifications status, along with the names of any LGBTBE-certified subcontractors included in their bid proposal.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller Checklist - B2727881.pdf | ||
| Micro Purchase Terms and Conditions B2727881.pdf | ||
| Consent_Authorization B2727881.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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