Required Vendor Application Form.pdf

This is a Vendor Application Form for the Borough of Naugatuck, Connecticut, designed to collect comprehensive vendor information for potential service or product providers. The form requests detailed vendor identification, including company name, tax identification numbers, business structure (C Corporation, S Corporation, Partnership, LLC, Individual/Sole Proprietor, or Trust/Estate), and contact information for sales points of contact. Vendors must specify whether they provide services, products, or both, and if services are involved, indicate the performance location (borough property or vendor's location). The application requires documentation of state licensing credentials if applicable to the work performed in Connecticut, with provisions for individual employee licenses for specialized trades such as electrical or HVAC work. Service vendors must submit a Certificate of Insurance (COI), a completed W-9 form, and a signed Insurance Agreement to the Purchasing Department. The form includes a department-use section for tracking expected annual purchases, anticipated purchase authority, general ledger line item classification, and payment processing status.

The vendor application form does not specify pricing terms, contract duration, renewal options, or funding amounts, as it serves as a preliminary qualification document rather than a solicitation with defined financial terms. There are no set-asides for disadvantaged enterprises indicated on this form, and no incumbent vendor information is provided. The form is a standard administrative tool used by the Borough of Naugatuck to establish and maintain a vendor database for future procurement activities, including the hauling and recycling services RFP (Contract No. FY27-B121) with a submission deadline of April 28, 2026 at 11:00 AM EDT. Interested vendors should direct inquiries to Jennifer Scully at 203-720-7025 or jscully@naugatuck-ct.gov.