Required Vendor Application Form.pdf

This is a Vendor Application Form issued by the Borough of Naugatuck, Connecticut, designed to establish pre-qualified contractor rosters for electrical, plumbing, and HVAC services under Request for Qualifications (RFQ) Contract No. FY27-B122. The solicitation opened on April 10, 2026 at 2:30 PM EDT and closes on April 28, 2026 at 11:00 AM EDT. Prospective vendors must submit applications indicating whether they provide services, products, or both, and specify the type of work performed (electrical, plumbing, HVAC, or other mechanical services). Service vendors must identify whether work will be performed at borough properties or vendor locations and must submit current state licensure credentials if required by Connecticut law, including individual licenses for employees performing onsite work. All service vendors are required to provide a Certificate of Insurance (COI) and execute a signed Insurance Agreement with the Town. Inquiries should be directed to Jennifer Scully at 229 Church Street, Naugatuck, CT 06770, by telephone at 203-720-7025 or email at jscully@naugatuck-ct.gov.

Vendors must complete IRS Form W9 documenting their federal tax identification number and provide their company name as shown on federal tax returns, alternate business names, and current business structure classification (C Corporation, S Corporation, Individual/Sole Proprietor, Single Member LLC, or Partnership). The application requires vendor contact information, mailing and payment addresses if different from the primary address, and designation of a point of contact for sales. No specific contract term length, renewal options, funding amounts, budget ranges, award values, or set-aside designations are disclosed in this application form. The Town will utilize the completed vendor applications to populate a pre-qualified contractor roster; specific service scope details, qualification requirements, and evaluation criteria are contained in supplementary RFQ documentation. No incumbent contractor information, site visit requirements, or bidder conference details are specified in this form.