LGBTQ Applicant Data Form B2727901.pdf
PDF 2 MB Posted
- Attached to
- DRIFTCON ACQUISITION CARD
- Solicitation number
- B2727901
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form from the City of Philadelphia's Procurement Department, designed to collect diversity and inclusion information from businesses seeking to contract with the city. The form requests applicants to provide their business name and bid or opportunity number, then answer a series of questions regarding LGBTQ business ownership and certification status. The form is administered by the City of Philadelphia's Procurement Department located at 1401 JFK Boulevard, Room 1700B, Philadelphia, PA 19102-1685, and applies to the Driftcon Acquisition Card contract opportunity with a contract period from July 1, 2026, to June 30, 2027. Applicants are asked to identify whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether they hold current certification as an LGBTBE through the National LGBT Chamber of Commerce (NGLCC) via its Philadelphia affiliate, the Independence Business Alliance (IBA).
The form also requests information regarding any additional third-party certifications held by the applicant business, 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), along with the specific certification categories received. Additionally, applicants must disclose whether any of their subcontractors are LGBTBE-certified by NGLCC/IBA and provide the names of all certified subcontractors. Response to the form is entirely voluntary, and by submitting it, applicants agree that the City of Philadelphia may use the data for other projects and may make the information publicly available. This data collection effort supports the City's commitment to diversity, equity, and inclusion in procurement and assists in building a 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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