LGBTQ Applicant Data Form B2728158.pdf
PDF 2 MB Posted
- Attached to
- Washers and Dryers
- Solicitation number
- B2728158
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form developed by the City of Philadelphia's Procurement Department to collect diversity and inclusion information from vendors seeking to do business with the city. The form requests applicants to self-identify whether their business is beneficially owned and controlled by persons who identify as Lesbian, Gay, Bisexual, Transgender, or Queer. The document is associated with a micro purchase opportunity for Washers and Dryers in Pennsylvania, which will be awarded as a whole or by line item to the lowest responsive and responsible bidder. Sellers must quote all items to be eligible for award, and no delivery or services should commence until notification is received from the department.
The data collection form is entirely voluntary and serves to identify LGBTQ-owned businesses currently doing business with the City of Philadelphia and to facilitate inclusion of LGBTQ certified businesses into the city's vendor database. The form also inquires whether applicants hold current certification as a Lesbian, Gay, Bisexual, Transgender Business Enterprise (LGBTBE) from the National LGBT Chamber of Commerce through the Independence Business Alliance, or certifications from other third-party certifying agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. Additionally, the form requests identification of any LGBTBE-certified subcontractors. By submitting the form, applicants agree that the City may use the submitted data for other projects and may make it publicly available.
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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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