Required Vendor Application Form.pdf

PDF 63 KB Posted

Attached to
Contract No. FY27-B116-RFP for the Purchase of Tires and Service
Solicitation number
36115
Issued by
New Haven County, Connecticut

About this file

This is a Vendor Application Form for the Borough of Naugatuck, Connecticut, used to register vendors for potential procurement opportunities with the municipality. The form requests comprehensive vendor information including business structure, licensing credentials, service or product type, and documentation of insurance and tax compliance. For Contract No. FY27-B116, the Town of Naugatuck issued a Request for Proposal for the purchase of tires and related tire service with a solicitation opening on April 10, 2026 at 2:45 PM EDT and closing on April 28, 2026 at 11:00 AM EDT. The RFP does not document site visits, bidders' conferences, or formal question and answer periods. Detailed specifications and requirements are contained in the supplemental document "FY27-B116 Tires and Services.pdf," and vendors are expected to submit vendor-specified pricing structures as part of their responses.

The solicitation documentation does not disclose specific contract term lengths, renewal options, set-aside designations, or anticipated award dates. No estimated total contract value or budget range has been disclosed in the primary solicitation materials. Vendors must submit a completed W9, Certificate of Insurance (COI), and signed Insurance Agreement as part of the application process. All vendor inquiries should be directed to Jennifer Scully, Procurement Contact, Town of Naugatuck, 229 Church Street, Naugatuck, CT 06770, by telephone at 203-720-7025 or by email at jscully@naugatuck-ct.gov.

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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 .