LGBTQ_Applicant_Data_Form_B2728182.pdf
PDF 2 MB Posted
- Attached to
- Aquascope (Exeter) supply
- Solicitation number
- B2728182
- 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 conjunction with state and local contract opportunities, specifically the Aquascope (Exeter) supply purchase in Pennsylvania. The form is designed to collect voluntary demographic information from applicants regarding LGBTQ business ownership and certification status. The City of Philadelphia uses this data to identify the number of LGBTQ-owned businesses interested in conducting business with the municipality and to facilitate inclusion of LGBTQ certified businesses into the City's vendor database. Applicants are asked to provide their business name and bid or opportunity number, along with responses to questions regarding beneficial ownership and control by LGBTQ persons, current certification status through the National LGBT Chamber of Commerce (NGLCC) via the Philadelphia-based Independence Business Alliance (IBA), and any additional third-party certifications such as MBE, WBE, DSBE, or DBE designations.
The form also requests information regarding any LGBTQ-certified subcontractors participating in the contract opportunity, with space to list multiple subconsultant business names. By submitting the form, applicants agree that the City may use the submitted data for other projects and may make it publicly available. Notably, response to the form is entirely voluntary and carries no bearing on bid evaluation or award decisions. The form does not establish set-asides, pricing preferences, or special consideration for LGBTQ-owned businesses; rather, it serves purely as a data collection mechanism to support the City's diversity, equity, and inclusion procurement initiatives.
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Other files
| File | Type | Posted |
|---|---|---|
| SOP Terms and Conditions B2728182.pdf | ||
| Seller_SOP_Checklist B2728182.pdf | ||
| Consent_Authorization_B2728182.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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