LGBTQ_Applicant_Data_Form_B2728222.pdf
PDF 2 MB Posted
- Attached to
- Three Screen Led Wall Package
- Solicitation number
- B2728222
- 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 B2728222 related to a Three Screen Led Wall Package procurement. The form is designed to collect demographic information from applicants to identify the number of LGBTQ-owned businesses interested in conducting business with the City. The data collected will be used to support the City's commitment to diversity, equity, and inclusion in procurement activities and may be incorporated into the City's vendor database. Applicants are asked to provide their business name, bid or opportunity number, and indicate whether their business is beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer.
The form requests information regarding current LGBTBE certification status through the National LGBT Chamber of Commerce (NGLCC) and its Philadelphia affiliate, the Independence Business Alliance (IBA), as well as any additional third-party certifications such as MBE, WBE, DSBE, DBE, or certifications from organizations including the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, and Disability:IN. Applicants must also identify any LGBTBE-certified subcontractors participating in the bid. Submission of this form is entirely voluntary, and the City reserves the right to use the submitted data for other projects and to make it publicly available. This small order purchase will be awarded as a whole to the lowest responsive and responsible bidder, with all items required to be quoted for award eligibility. No services shall be delivered until notification is received from the department.
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Other files
| File | Type | Posted |
|---|---|---|
| Seller_SOP_Checklist_B2728222.pdf | ||
| Consent_Authorization_B2728222.pdf | ||
| SOP_Terms_and_Conditions_B2728222.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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