LGBTQ_Applicant_Data_Form - B2728230.pdf
PDF 2 MB Posted
- Attached to
- Storage boxes
- Solicitation number
- B2728230
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form for the City of Philadelphia's procurement process, designed to collect diversity and inclusion information from vendors seeking to do business with the municipality. The form requests applicant identification and bid or opportunity number, along with responses to three primary questions regarding LGBTQ business ownership and certification status. Applicants are asked to indicate whether their business is beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer; whether they hold current LGBTBE certification from the National LGBT Chamber of Commerce through the Independence Business Alliance; and whether any subcontractors involved in the contract opportunity are LGBTQ-certified. If applicants hold LGBTBE certification, they are also asked to identify any additional third-party certifications from organizations such as the Eastern Minority Supplier Development Council, Pennsylvania Unified Certification Program, Disability:IN, or Women's Business Enterprise National Council.
The City of Philadelphia is collecting this data voluntarily to identify LGBTQ businesses currently engaged in city procurement and to facilitate inclusion of LGBTQ-certified businesses in the city's vendor database. Applicants submitting the form agree that the City may use the data for other projects and may make it publicly available at its discretion. The form contains multiple checkbox fields for yes/no responses and space to list subcontractor business names and certifying agencies. This particular data collection is associated with a small order purchase for storage boxes to be awarded as a whole or by line item to the lowest responsive and responsible bidder, with all items required to be quoted for award eligibility.
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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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