LGBTQ Data Form.pdf
PDF 2 MB Posted
- Solicitation number
- 21261002104434
- Issued by
- Philadelphia County, Philadelphia City, Pennsylvania
About this file
This is an LGBTQ Data Form document associated with the Philadelphia Department of Public Health's Injury Prevention Program, which is soliciting proposals for violence intervention initiatives in Pennsylvania. The form appears to be a data collection or demographic instrument designed to gather information about LGBTQ populations, likely to support needs assessment and program planning for the violence intervention proposals. The document serves as a supporting exhibit to the primary solicitation for initiatives addressing strategic priority areas related to enhancing the city's violence intervention efforts.
The form functions as a tool to ensure culturally competent and inclusive program design by collecting relevant demographic and social data from LGBTQ respondents or participants. This data collection mechanism reflects the Department of Public Health's commitment to understanding the specific needs, vulnerabilities, and experiences of LGBTQ communities in relation to violence prevention and intervention. The form supports evidence-based proposal development by enabling applicants to demonstrate awareness of and responsiveness to LGBTQ community needs within their proposed violence intervention strategies.
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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 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 #
| 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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