LGBTQ Applicant Opportunity Data Form B2727716.pdf
PDF 2 MB Posted
- Solicitation number
- B2727716
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Opportunity Data Form associated with a Pennsylvania micro purchase bid for permethrin spray, hi-visibility safety vests, and hi-visibility safety bucket hats. The form is designed to collect voluntary demographic information from applicants to identify businesses beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals who wish to conduct business with the City. The data gathered will be used to track the number of LGBTQ businesses currently engaged with the City and to facilitate the inclusion of LGBTQ certified businesses into the City's vendor database. The micro purchase will be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsible bidder. All sellers must quote all items to be eligible for award.
The form requests applicants to identify whether their business is beneficially owned and controlled by LGBTQ persons, whether they hold current certification as an LGBTBE through the National LGBT Chamber of Commerce (NGLCC) or its Philadelphia affiliate, the Independence Business Alliance (IBA), and whether they hold certifications from other third-party agencies such as ESMDC, PAUCP, Disability:IN, or WBENC. Applicants are also asked to identify any subcontractors certified as LGBTBE. Completion of this form is entirely voluntary and represents part of the City's broader commitment to diversity, equity, and inclusion in procurement activities.
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Other files
| File | Type | Posted |
|---|---|---|
| orange safety hat_2 pack.jpg | JPG image | |
| permethrin.jpg | JPG image | |
| hivis safety vest_zipper.jpg | JPG image | |
| Consent_Authorization_B2727716.pdf | ||
| Seller_SOP_Checklist B2727716.pdf | ||
| Micro Purchase Terms and Conditions B2727716.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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