LGBTQ_Applicant_Data_Form B2728110.pdf
PDF 2 MB Posted
- Solicitation number
- B2728110
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department for contract opportunity B2728110, specifically related to the CCOM Election Warehouse Plastic Bags and Slider Bags micro purchase. The form is designed to collect demographic information from applicants regarding LGBTQ business ownership and certification status. Applicants are required to indicate whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer, and to provide certification details if applicable. The form requests information about current LGBTBE certification through the National LGBT Chamber of Commerce (NGLCC) or its Philadelphia-affiliated Independence Business Alliance (IBA), as well as any additional third-party certifications from agencies such as the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council. Applicants must also disclose any subcontractors certified as LGBTBE.
The data collected through this form is voluntary and intended to support the City of Philadelphia's commitment to diversity, equity, and inclusion in procurement activities. The City reserves the discretion to use the submitted data for other projects and may make it publicly available. This particular micro purchase for Election Warehouse plastic bags and slider bags will be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder. Submission of the LGBTQ Applicant Data Form does not impose any contractual obligations but facilitates the City's efforts to identify and include LGBTQ-certified businesses in its vendor database.
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Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization B2728110.pdf | ||
| Micro Purchase Terms and Conditions B2728110.pdf | ||
| Seller SOP Checklist - B2728110.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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