LGBTQ_Applicant_Data_Form_B2727940.pdf
PDF 2 MB Posted
- Attached to
- 20' High Cube Storage Container
- Solicitation number
- B2727940
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department for use in connection with state and local contract opportunities, specifically a micro purchase for a 20' High Cube Storage Container. The form is designed to collect voluntary demographic data from applicants regarding LGBTQ business ownership and certification status. Applicants are asked to indicate whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether the business holds current certification as an LGBTBE through the National LGBT Chamber of Commerce (NGLCC) via the Philadelphia affiliate, the Independence Business Alliance (IBA). The form also requests information regarding any additional third-party certifications from organizations such as the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council, as well as identification of any LGBTBE-certified subcontractors involved in the opportunity.
The City of Philadelphia has implemented this data collection initiative as part of its commitment to diversity, equity, and inclusion in municipal procurement. Response to the form is entirely voluntary, and applicants are informed that submitted data may be used by the City for other projects and may be made publicly available at the City's discretion. The collected information will be utilized to identify the number of LGBTQ-owned businesses currently engaged with the City and to facilitate the inclusion of LGBTQ certified businesses in the City's vendor database.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller_SOP_Checklist_B2727940.pdf | ||
| Consent_Authorization_B2727940.pdf | ||
| MP_Terms_and_Conditions_B2727940.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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