LGBTQ Applicant Data Form B2727963.pdf
PDF 2 MB Posted
- Attached to
- Brady Printer Accessories
- Solicitation number
- B2727963
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form related to a micro purchase opportunity for Brady Printer Accessories with the City of Pennsylvania. The form serves as a certification and data collection document for applicants seeking to participate in or be considered for this procurement opportunity. The Brady Printer Accessories micro purchase will be awarded as a whole or by line item, whichever serves the best interest of the City, to the lowest responsive and responsible bidder. Sellers must quote all items to be eligible for award consideration, and no delivery or services should commence until formal notification is received from the department.
The form functions as a documentation tool for LGBTQ applicant identification and tracking purposes within the procurement process. This data collection mechanism allows the City to monitor participation and engagement from LGBTQ-owned or LGBTQ-led businesses in municipal contracting opportunities. Specific pricing terms, set-aside provisions, response deadlines, and contract duration details would be contained in the primary procurement documents; however, this form specifically captures demographic and business classification information to support diversity and inclusion initiatives in the City's procurement practices.
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Text version
LGBTQ Applicant Opportunity Data
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’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. Response to this form is voluntary.
Applicant Name
Bid or Opportunity #
| 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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