LGBTQ_Applicant_Data_Form_B2728285_.pdf
PDF 2 MB Posted
- Attached to
- Ticket dispenser
- Solicitation number
- B2728285
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form related to a ticket dispenser micro purchase opportunity for the Commonwealth of Pennsylvania. The form serves as a supplemental application document for vendors responding to the solicitation, requiring bidders to provide information regarding their status as LGBTQ-owned business enterprises. 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. Sellers must quote all items to be eligible for award and should not deliver products or provide services until receiving official notification from the purchasing department.
The form functions as a self-certification mechanism to identify and track LGBTQ-owned business participation in the procurement process. All bidders are required to complete this form as part of their application package, regardless of their business classification status. This documentation supports the city's diversity and inclusion initiatives by capturing data on LGBTQ vendor participation while maintaining the competitive bidding process based on price and responsibility factors.
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Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B2728285_.pdf | ||
| Seller_SP_Checklist_B2728285_.pdf | ||
| B2728285 Location Sheet.pdf | ||
| MP_Terms_and_Conditions_B2728285_.pdf |
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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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