LGBTQ Data Form.pdf
PDF 2 MB Posted
- Solicitation number
- 21260612171032
- Issued by
- Philadelphia County, Philadelphia City, Pennsylvania
About this file
This is an LGBTQ Applicant Opportunity Data Form used by the City of Philadelphia to collect demographic and certification information from organizations bidding on government contracts. The form is designed to identify businesses that are beneficially owned and controlled by individuals who self-identify as Lesbian, Gay, Bisexual, Transgender, or Queer. Applicants are asked to indicate whether their business holds LGBTBE certification through the National LGBT Chamber of Commerce (NGLCC) via the Independence Business Alliance (IBA), Philadelphia's local affiliate, and to identify any additional third-party certifications held through organizations such as the Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN, or Women's Business Enterprise National Council (WBENC). The form also requests information about any subcontractors certified as LGBTBE.
The City of Philadelphia is collecting this data as part of its commitment to diversity, equity, and inclusion in procurement activities. Response to the form is entirely voluntary, and the City has discretion to use submitted data for other projects and may make the data publicly available. Applicants are required to provide their business name, bid or opportunity number, and relevant certification status information. This initiative supports the City's effort to identify LGBTQ-owned businesses currently conducting business with the municipality and to expand the representation of LGBTQ certified enterprises within the City's vendor database.
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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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