LGBTQ Applicant Data Form B2728273.pdf
PDF 2 MB Posted
- Attached to
- External Hard Drive
- Solicitation number
- B2728273
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form used by the City of Philadelphia in conjunction with a micro purchase opportunity for external hard drives. The form is designed to collect voluntary diversity data from applicants bidding on state and local contracts in Pennsylvania. The micro purchase will be awarded as a whole or by line item, whichever serves the City's best interests, to the lowest responsive and responsible bidder. Applicants must quote all items to be eligible for award, and delivery or service provision should not commence until formal notification is received from the contracting department.
The form requests information regarding whether the applicant's business is beneficially owned and controlled by persons identifying as Lesbian, Gay, Bisexual, Transgender, or Queer, and whether the business holds LGBTBE certification through the National LGBT Chamber of Commerce via the Independence Business Alliance in Philadelphia. Applicants are also asked to identify any additional third-party certifications held, such as MBE, WBE, DSBE, or DBE designations, and to list any LGBTBE-certified subcontractors participating in the bid. The City uses this data to track LGBTQ business participation in procurement, support diversity and inclusion initiatives, and expand the vendor database to include certified LGBTQ-owned enterprises.
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Text version
LGBTQ Applicant Opportunity Data
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’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. Response to this form is voluntary.
Applicant Name
Bid or Opportunity #
| 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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