Required Vendor Application Form.pdf

PDF 63 KB Posted

Attached to
Contract No. FY27-B127-Request for Proposal for Rental of Portable Toilets
Solicitation number
36052
Issued by
New Haven County, Connecticut

About this file

This is a Vendor Application Form issued by the Borough of Naugatuck, Connecticut for the procurement of portable toilet rental services under Contract No. FY27-B127. The Request for Proposal was released on April 10, 2026, with proposals due on April 28, 2026, at 11:00 AM EDT. The solicitation does not specify quantities, delivery terms, site visit requirements, or a bidders' conference. No estimated total contract value, contract term length, renewal options, or award date is provided in the available documentation. Vendors are responsible for determining their own pricing and payment terms as integral components of their proposals. Inquiries should be directed to Jennifer Scully, Purchasing Agent, at 203-720-7025 or jscully@naugatuck-ct.gov.

The application form requires vendors to provide comprehensive business information including W-9 tax documentation, proof of any required state licenses specific to the work performed, and a Certificate of Insurance (COI) along with a signed Insurance Agreement. The form accommodates various business entity types including C Corporations, S Corporations, sole proprietors, single-member LLCs, partnerships, trusts, and estates. No set-asides, disadvantaged enterprise designations, incumbent vendor information, or restrictions on organization types are identified in the solicitation materials. Vendors must indicate whether services will be performed at borough property or at the vendor's location and declare whether Connecticut state licensure is required for the work. The solicitation materials do not specify contract funding sources, amounts, or other financial requirements beyond standard vendor compliance 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 .