New_City_Vendor_Form_09-17-25.pdf

PDF 135 KB Posted

Attached to
Citywide Arts & Culture Events and Pop-Up Markets
Solicitation number
2025-RFP-CNH-297
Issued by
New Haven County, Connecticut

About this file

Written by GovTribe AI ·

This is a Vendor Application Form designed for the City of New Haven, Connecticut, Department of Arts & Culture to onboard and manage vendors for municipal contracts and grant programs. The form serves as the primary documentation tool for establishing new vendor relationships or modifying existing vendor records within the city's vendor management system. Prospective vendors must complete all required sections, including company information, tax identification details, payment and remittance addresses, authorized signatories, and contact information. Additionally, vendors are required to submit a completed W-9 form and a disclosure form as mandatory attachments to process the application. The form accommodates both new vendor registrations and modifications to existing vendor records, such as address changes or remittance updates, and requires submission to both the Tax Office and Assessor's Office for approval before processing.

The application collects critical information to determine vendor eligibility, including designation as a small business or minority-owned business, 1099 reporting requirements, and verification of any existing employment relationships with the City or Board of Education. Authorized representatives designated to act on behalf of the vendor must be identified with supporting personal information, including social security number (last four digits), date of birth, and citizenship status. The form includes internal processing sections for city staff to track vendor number assignments, processing dates, and approvals from the Tax Office and Assessor's Office. No specific pricing terms, contract amounts, or funding sources are detailed within this vendor application form, as it functions as a prerequisite enrollment document rather than a contract or solicitation document with financial specifications.

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VENDOR APPLICATION FORM

Please ensure a W-9 and disclosure form is attached to this request.

Please fill out this form completely as instructed.

Section 1. Vendor Information Date Requested Is This A New Vendor Or Vendor Modification (Type As “N” Or “Vm”) If This Is An Existing Vendor Modification, Please Provide The Vendor No.

What Type Of Vendor Modification (i.e address change, remit add, remit change, etc))

Company / Firm Name As Shown On Federal Tax Return Tax Id Number (FEIN Or SS)

Doing Business As (Dba) Name If Applicable Unique Entity Id (Uei) Required For Federal Awards / Grants

Business Place Of Incorporation/Registry Cage Number

Address

City State Zip

Section 2. Payment and Remit Address Address

City State Zip

Section 3. Vendor Contact Information General Contact(S) Name TITLE PHONE EMAIL

Authorized Signer(S) – Individuals Who Can Bind/Sign Agreements/Contracts Name TITLE PHONE EMAIL

Section 4. Additional Vendor Information Is The Vendor To Receive A 1099? Is a W-9 Attached Is a disclosure form attached

Yes Yes Yes No No No

Are you considered a small Business

Are you considered a Minority Owned

Yes Yes No No

Is This An Employee Of The City Or Boe? If marked yes, Please Provide Their Department And Employee Number

YES DEPARTMENT

NO EMPLOYEE

NO.

Section 5. City Request and Approvals Requestor Name Date Of Request City/Boe Department

Add a Representative(s) to your business account. This includes any individual designated to act on behalf of your business.

Name SSN (Last 4 digits) Date of Birth (DOB)

Address

City State Zip Code Country of Citizenship

Second authorized representative (if applicable)

Name SSN (Last 4 digits) Date of Birth (DOB)

Address

City State Zip Code Country of Citizenship

Representative Signature:

Date:

Tax Office Approved Or Denied (If Denied, Attach A Copy Of Tax Bill)

Date

Assessors Office Approved or Denied Date

Request will not be processed without all field accurately filled out and proper documentation.

Section 6. Internal Use Only Vendor Number

Date Received

Date Processed

Employee who processed

Is This A New Vendor Or Vendor Mod i f i cat i on Type As N Or Vm:
Vendor Modification:
What Type Of Vendor Mod i f i cat i on i e address change rem i t add rem i t change etc:
change etc:
Company Firm Name As Shown On Federal Tax Return:
Tax Id Number FEIN Or SS:
Doing Business As Dba Name If ApplicableRow1:
Unique Entity Id Uei Required For Federal Awards GrantsRow1:
Business Place Of Incorporation Registry:
Cage Number:
Address:
City:
State:
Zip Code:
Payment/Remit Address:
Payment/Remit City:
Payment/Remit State:
Payment/Remit Zip Code:
General Contact Name:
General Contact Title:
General Contact Phone #:
General Contact Email:
General Conatct Name 2:
General Contact Title 2:
General Contact Phone # 2:
General Contact Email 2:
Authorized Signer Name:
Authorized Signer Title:
Authorized Signer Phone #:
Authorized Signer Email:
Authorized Signer Name 2:
Authorized Signer Title 2:
Authorized Signer Phone # 2:
Authorized Signer Email 2:
Date1_af_date:
Is the Vendor to recieve a 1099?: Off
Is a W-9 Attached?: Off
Is a disclosure form attached?: Off
Are you considered a small business?: Off
Are you considered a minority ownerd?: Off
DEPARTMENT:
EMPLOYEE NO:
Is this an employee of the city or boe?: Off
Requestor Name:
Date Of Request:
City/Boe Department:
Tax Office:
Approved or Denied:
Assessors Office:
Approved or Denied 2:
Vendor Number:
Emp l oyee who processed:
Date2_af_date:
Date3_af_date:
Date4_af_date:
Date5_af_date:
Authorized Representative 1:
Representative SSN 1:
Representative DOB 1:
Representative Address 1:
Representative Zip Code 1:
Representative State 1:
Representative City 1:
Representative Citizenship 1:
Authorized Representative 2:
Representative SSN 2:
Representative DOB 2:
Representative Address 2:
Representative City 2:
Representative State 2:
Representative Zip Code 2:
Representative Citizenship 2:
Date6_af_date:

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