Required Vendor Application Form.pdf

PDF 63 KB Posted

Attached to
Contract No. FY27-B114- RFQ for Fence Repair and Replacement
Solicitation number
36086
Issued by
New Haven County, Connecticut

About this file

This is a Vendor Application Form issued by the Borough of Naugatuck, Connecticut for the Contract No. FY27-B114 RFQ for Fence Repair and Replacement. The solicitation seeks qualified vendors to provide fence repair and replacement services for borough properties. The bidding period opens on April 10, 2026 at 8:00 AM EDT and closes on April 28, 2026 at 11:00 AM EDT, with all proposals required to be submitted by the closing deadline. Prospective bidders should direct inquiries to Jennifer Scully at the Town of Naugatuck, 229 Church Street, Naugatuck, CT 06770, via telephone at 203-720-7025 or email at jscully@naugatuck-ct.gov. The solicitation does not specify quantities, detailed project requirements, site visit requirements, bidders' conferences, or award dates; comprehensive project specifications are contained in the referenced attachment "FY27-B114 Fence Repair Replacement.docx."

The vendor application form requires submission of completed documentation including a W9 form, Certificate of Insurance (COI), and signed Insurance Agreement. Vendors must identify their organization type (Corporation, S Corporation, Individual/Sole Proprietor, Single Member LLC, Partnership, Trust/Estate, or Other) and indicate whether state licensure is required to perform work in Connecticut, with credentials and individual employee licenses to be provided if applicable. The form requests vendor information including mailing address, point of contact for sales, Federal Tax ID or SSN, business type classification, and expected annual purchase amounts. The solicitation contains no estimated contract value, pricing structure details, budget range information, set-aside designations, incumbent contractor information, or specific evaluation criteria in the available documentation.

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Text version

VENDOR INFORMATION

PO MAILING ADDRESS if different from above

POINT OF CONTACT FOR SALES - NAME & TITLE POC EMAIL

ORGANIZATION TYPE (Please submit completed W9)

VENDOR TYPE

SERVICE Type of Service

PRODUCT Type of Product

BOTH

SERVICE VENDORS

Where will the Service be performed: Borough Property Vendor's location

Is a State Licens Required to perfom work in the State of Connecticut? YES NO If Yes:

Credential Number (also provide a copy of current license) **Also provide individual license copy for employees performing work onsite(i.e. Electrical license, HVAC, etc)

NOTE: Service Vendors require a COI to be sumitted to Purchasing, as well as a signed Insurance Agreement

DEPARMENT USE ONLY

Expected Annual Purchase $$

Anticipated Purchase Authority (reason for adding vendor)

Which line item from your GL will this Vendor fall under?

Will we be processing payments for this Vendor? YES NO

Documents obtained: W9 COI Signed Insurance Agreement

VENDOR ID. If applicable

TAX ID NUMBER FEIN OR SSN

COMPANY / FIRM NAME as shown on Federal Tax Return

ALTERNATE NAME if applicable/(doing business as)

VENDOR ADDRESS

PAYMENT ADDRESS if different from above

PHONE

Limited Liability Company. (C=Corp, S=S Corp, P=Partnership

Trust/estate

Other

FAX WEBSITE

VENDOR APPLICATION FORM

BOROUGH OF NAUGATUCK

229 Church Street

Naugatuck, CT 06770

Type of License for Business: (Electrical, Mechanical, HVAC, etc.)

C Corporation

S Corporation

Individual/Sole Proprietor or Single Member LLC

Partnership

File details come from the government source that posted it. Updated .