Required Vendor Application Form.pdf
PDF 63 KB Posted
- 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 .