Board of Selectmen - 55 (05/03/2022)

FINANCE DEPARTMENT
Memo
To: 
The Board of Selectmen
From: 
Rawle Dummett
cc: 
Kim Allen
Date: 
April 14, 2022
Re: 
Disposal of assets
The Purchasing Agent, on behalf of the Public Works Department, seeks permission
from the Board of Selectmen to dispose of the following assets, in accordance with
chapter 3.08.020 of the Ordinance.
e 
H-50V-VACALL (body only) Year: 2004
Model: LV10C Engine Hours - 1,643 Asset - #100012
« 
Old S-26 (garbage truck) Year: 2011
Make/Model: Peterbilt 320
VIN - 3BPZL50X0BF 129188
Mileage - 97,329
Asset - # 101044
e 
1970 Paving Machine (yellow) Not on the asset list
« 
4 Portable Toilet Seats Found at the Town Hall (Seats only) - no buckets
Not on the asset list 
.
« 
1959 Ferguson Tractor
Serial # SGM193199 Asset - #9204030434

« 
Snap-On Solus Edge traded in for Snap-On Triton
Mechanic Software Too!
« 
Tag# 00189 - Cabinet for computer
equipment
own of Waterford
Rawle Dumm 
uv)
Parchasing 
Agent

FIFTEEN ROPE FERRY ROAD
WATERFORD, CT 06385-2886
PHONE; 860-442-0553
www,waterfordct.org
DATE: 
April 13, 2022
TO: 
Rawle Dummett, Purchasing Agent
FROM: 
Gary J. Schneider, Director of Public Works
SUBJECT: 
Surplus Vehicles / Equipment
The Department recommends declaring for surplus the following vehicles and pieces of equipment.
Declare Surplus:
Declare Surplus:
Declare Surplus:
Declare Surplus:
Declare Surplus
H-50V — VACALL (body only)
Year: 2004
Model: LV10C
Engine Hours — 1,643
Asset - #100012
Old S-26 (garbage truck)
Year: 2011
Make/Model: Peterbilt 320
VIN - 3BPZL50X0BF 129188
Mileage — 97,329
Asset - #101044
1970 Paving Machine (yellow)
Not on the asset list
4 Portable Toilet Seats
Found at the Town Hall
Seats only ~ no buckets
Not on the asset list
1959 Ferguson Tractor
Asset #9204030434
Serial 
# SGM193199
Asset - # 9204030434

The following software tool was traded in on the new version of the software.
Declare Surplus: 
Snap-On Solus Edge traded in for Snap-On Triton
Mechanic Software Tool
The following items on the fixed asset listing should have been removed when the building was
demolished, but missed during the initial inventory of the asset list:
Tag# 00189 — Cabinet for computer equipment
Tag# 001888 — Disposal Oil Filter
Tag# 001893 — System Waste Oil
We respectfully request these items be forwarded for consideration to the Board of Selectman. If you
need further information, please contact our office,
Ce: 
Kim Allen, Director of Finance
Garon VanOverloop, Fleet Lead Mechanic

Bethe





MINUTES
BOARD OF SELECTMEN REGULAR MEETING
April 19 2022
5:00 P.M.
Waterford Town Hall (Appleby Room)
Members Present: First §electman Robert Brule, Selectwoman J, ody Nazarchyk and
Selectwoman Elizabeth Sabilia (unable to attend) 
~
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23
1. 
Cali to Order & Roll Call First Selectman Brule called the meeting ty
order at 5:00pm.’ 
o
2. 
Pledge of Allegiance
3. 
Publie Comment: None
4,
Disposition of Town Property (Ordinance, Chapter 2.1 12.020):
4a. Disposition of Recreatio
recommendation from Rawle
Recreation and Parks for the
n and Parks: Toc
Dummett, Purcha
disposal of the bel
onsider an act on a
sing Agent, on behalf of the
Ow outlived assets.
© 
Asset# 101276: Concert Staging
° 
Asset# 920403 0507: Pedestrian Bridge
Finance Department Bid AWARD
Improvement Project: To consider
Dummett, Purchas
Award to BE 
W P
Funds would be ay
- State Project 0170-3513 Jordan Village
and act ona recommendation from Rawle
ing Agent, on behalf of Public Works to approve a Bid
aving and Landscaping LLC in the amount of $3 00,471,
ailable from line item #20511-57856 Jordan Village Side Walks.
MOTION by Nazarchyk, and seconded by Brule, VOTING IN FAVOR: unanimous
VOTE:2-0

6. 
Public Works: To consider and act on the following request
for an appropriation of $1,705,358 from the CNR
Undesignated Fund #205-31520 to resurface several roads.
This request substitutes Gardiners Woods Road for Oil Mill
Road. If approved, please forward to the Board of Finance for
further consideration.
MOTION by Nazarchyk, and seconded by Brule, VOTING IN FAVOR:
unanimous VOTE:2-0
7. 
Public Works: To consider and act on the following request for an In
Series Transfer from the Public Works Director, Gary Schneider, in the
amount of $55,808.
MOTION by Nazarchyk, and seconded by Brule, VOTING IN FAVOR:
unanimous VOTE:2-0 
.
8. Appointments and Resignations: None
9. Correspondence:
9a. Letter from David Campo, Town Clerk-Waterford Electors to referendum
the Eversource Gas Line Agreement (Please see Attached letter)
10. New Business:
10a. American Rescue Funds
11. Consent Agenda
11a. Tax refund- In the amount of $60,424.39-APPROVED
11b. Minutes January 18, 2022-APPROVED
lic. Minutes February 15, 2022-APPROVED
1id. Minutes April 5, 2022-APPROVED
12. Adjournment-was made by Ms. Nazarchyk and seconded by Mr. Brule to
adjourn at 5:23pm. VOTING IN FAVOR; unanimous, VOTE:2-0
Respectfully Submitted,
pt
Cindy Dupointe
Recording Secretary

FINANCE DEPARTMENT
Memo
April 20, 2022
Mr. Rob Brule
First Selectman
Town of Waterford
15 Rope Ferry Road
Waterford, CT 06385
Re: Bid Award ~ BIDH22-120 Consulting Firms
Dear Mr, Brule,
On April 8, 2022, bids were opened for the above-mentioned project by Maryellen McConnell
and me with the attached results.
The Purchasing Agent on behalf of the Planning Department recommends the contract for
this project be awarded to the lowest qualified bidder Brianna Regine Visionary Consulting for
$66,000.00.
me 
ON available from Line Item 23507-58021 Waterford Small Business Grant,
| 
Sis
Rawle Dummett
Purchasing Agent,
Town of Waterford

FIFTEEN ROPE FERRY ROAD
DEPARTMENT OF PLANNING AND DEVELOPMENT
MEMORANDUM
TO: 
Rawle Dummett, Purchasing Agent
FROM: Abby Y. Piersall, AICP, Planning Director
DATE: April 19, 2022
TITLE: 
Recommendation for RFP (#22-120) Award for Consulting Services for the Waterford Small
Business Grant Program Management
Waterford has allocated $300,000 of American Rescue Plan Act (ARPA) funding to initiate a small
business grants program. The concept and general timeframe to develop this program has been initiated
by staff and the Economic Development Commission (EDC). To advance to project, the Town issued an
RFP for consulting services. The scope of services included final program development, advertising,
application assistance for small businesses, application screening, organizing applications for
presentation to the EDC, and managing communication and compliance, including reporting for ARPA
auditing purposes,
On April 14, 2022, the First Selectman, Finance Director, and Planning Director interviewed consultant
Brianna Régine, CEO of Brianna Régine Visionary Consulting. Her proposal to craft and manage the grant
program both met the required scope of work and was intended to leave the Town with a sustainable
small business grants program that could be continued should future funding be available. Her proposal
in the amount of $66,000 was the lower of two respondents and met all of the requirements of the RFP.
The second respondent, while qualified, proposed $299,250. Based on the proposal submitted in
response to RFP #22-120 and the subsequent interview with Town officials, it is recommended that the
project be awarded to Brianna Régine Visionary Consulting.
WATERFORD, CT 06385-2886 
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BRIANNA REGINE
Visionary Consulting
RFP #22-120
Produced by
Primary Contractor:
Brianna Régine Walston
CEO & Founder / Owner
Brianna Régine Visionary Consulting
On April 7, 2022

Brianna Regine Visionary Consulting
Primary Contact: Brianna Régine Walston
3. 
1000 Lafayette Bly. Suite too - 4108
Bridgeport, CT ob6e4
BRIANNA REGINE 
Busines:
Visionary Consulting
»AP9-QU9-4
Direct #: 203-Sa0-ag15
a
2 at
Manaik brinnta@hry 
istonar cousulling.com
Page 18 
~ S/MBE Certificate
Page ig 
~ 
23~ 
Commission on Human Rights and Opportunities Contract
Complianee Regulations Notification to Bidders
Kindly note, the full anssver to Part H, Question 12.0n affirmative action is written
below.) 
op Oger File
Page 24 - 27 
~ Insurance documents -Gr re tan Ale,
Tull response to Part it, Question 12, of Bidder Contract Compliance Monitoring Report)
Sitiee we are a team of contractors and not employees that work remotely, we don't
neeessarily have a hard copy of affirmative action and equal employment opportunity
statement. However, we are a company that priorities diversity, equity and inclusion
when expanding our team, maintaining a posttive/uplifting and high morale company
cullnre, and supporting our elicnts,
At this time, we 
do 
not 
have 
a 
written 
affirmative 
action 
plan 
nor 
equal
aiployment opporlunily statement because we're a team of contractors; 
and we
don't have more than So employees nora contract exceeding S30,000, Despite not
having this formal writen documentation, Brianna Regine Visionary Consulting's
enlture operates on good faith and adequate due diligenee thal’s mindful of the law,
and we conduct our biring process with 
an 
equal opportunity 
approach 
tbat
does’t reward race, color, religion, sex, 
national origin, ave, disability, marital
status, veleran status, sexual orientation, genetic information or any other protected
characteristic under applicable Jaw. ‘This applies 
to 
all) 
phases of the biring,
onboarding and off boarding processes. At the time of our contractor-only structure,
but also ifand when we do hire employees, Brianna Regine Visionary 
Consulting
will implement 
a written affirmative action statement that aligns with applicable
laws and Executive Orders lo support, protect and introduee/promote 
through 
the
workforce 
people 
identifying 
as 
minority 
group individuals, females, disabled
veterans, 
recently sepafated 
veterans, 
other protected veterans, Armed 
Forces
service 
medal 
velerans and 
qualified 
disabled 
persons. 
Qur etdture promotes
iransparency and therefore, all contractors are cnemuraged Lo report any experiences
of discrimination 
and 
harassment 
of any 
kind 
lo 
managers, 
without 
fear of
repercussions; and 
managers are 
frequently 
monitored 
to 
ensure cheeks 
and
balances.

Brianna Régine Visionary Consulting
Primary Contact: Brianna Régine Walston
1000 Lafayette Blyd. Suite too - 4108
Bridgeport, CP 06604
BRIANNA REGINE 
Business #: 495-999-4371
Visionary Consuiting 
. 
1 
. 
' 
, Direct 
o3 Hal 
Hla
Kail: briaina@bivisionayy consulting com
Foe Proposal
REP: 
4
22-120
Kindly note, all customized proposals are crafied with value in mind, not itemization. Fees reflect
the value of BRVC's support and therefore considers: time, elfort, expertise, returned tinie/energy
to the Client for other (asks, projected hours and the standard as well as eapacily to whieh services
are provided. Kindly note, oul of state travel on behalf 
of (he client isn’t included.
Total Fee for One Initial Year of Services - $66,000
We kindly request this be paid tn monthly installments of $5,300.
Inquiries 
about 
fees, 
negotiation 
and) 
payment 
methods 
can 
be 
addressed
lo
brianna@brvisionaryconsulting.com or 203-398-2915.
10

FIFTEEN ROPE FERRY ROAD 
WATERFORD, CT 06385-2886
TOWN OF WATERFORD
NON-COLLUSION STATEMENT
“The undersigned affirms that they are duly authorized to execute this contract, that this
company, corporation, firm, partnership or Individual has not prepared this bid in collusion with
any other bidder, and that the contents of this bid as to prices, terms or conditions of said bid
have not been communicated by the undersigned nor by any employee or agent to any other
person engaged in this type of business prior 
to the official opening of this bid.”
We understand that this proposal must be signed by an authorized agent of our company to
constitute a valid proposal.
Date:
Alexie
Name of Company:
Le 
x 
Mana
oe
Name and Title of Agent:
Paaone 
O rate = O8D+ Funde-| dre
By (SIGNATURE):
ae ae
_B
Address:
1S 
Burl 
-Guie. WOD - Ho’
v1 Ck OBGOY
Telephone Number:
Sosingss: THS- 999 - YF 
91
Oriccer, tos- 52g 2915

CONTRACTOR INFORMATION SHEETS
(These sheets must be completed and included with Bid)
COMPANY NAME: 
Avian. 
“as 
Wisi 
AR
man vey
ADDRESS: 
: oer’ Ct O’GOT
GesWeren YS Diwan Sree Sor, Ce Oey oy 
‘
ESTABLISHED: _3 prewar 1 DAF
(Month) (Year)
TYPE OF ORGANIZATION: (Circle One)
A) Individual
B) Partnership
C) Corporation
DLicint Venture
GE her Law, Wek Lraraucn, Corea ftics
pecify)
(if Applicable)
FORMER FIRM NAME(S) YEARS IN BUSINESS
Att
YEARS OF WORK INA RELATED FIELD: ++
(Described Any Related Work)
CH MARRY Rein tb Ochi yn Smeets 
5615 beree 
& CY ofB en 
ok
tee. Pes! Pots luelers, Duhaces * Ctrarut. Theres, fae Reps -farts = Once Br
Qin a5 Lorn os cher 
dros Monessen, Ae, (espero
EQUIPMENT AND EMPLOYEES:
Provide alist (attached to this sheet) of equipment and employees anticipated to be utilized for this work.
Bee Prteses. deGurenns ~ legtepo Hs On Smartrens Ge aby Wuyrenc thems |
USE OF SUBCONTRACTORS: 
7+ “eC oscds
To provide all the services listed in the specifications, would any services be handled by
subcontractors? Yes 
Yes/No if “Yes”, please explain:
fanzox Wu ne, Peter 
oe Vn, Branca. Qe Fice. Loca dhun A fy ae see tS,
Bry Ordon ie Darnxverders lit Vw Brae oh wile + Sawer oh- Vag Riu of
unrve fuel
Subcontractor Name(s}: Mere. Punkeve,
See’ latices.
PROJECT MANAGER: Uineyce he ce WA Sens

COMPLETE AND RETURN
Bid# 22-10
Bid TITLE:Consniny, Ferme
NON-CONFLICT AFFIDAVIT OF RESPONDENTS
No Elected or Appointed Official, SBC member or other officer or employee or person whose salary is payable
in whole or in part from the Town of Waterford OR Board of Education, nor any immediate family member
thereof, is directly or indirectly interested in the Bid/Proposal, or in the supplies, materials, equipment, work
or labor to which it relates, or in any profits thereof.
The undersigned further certifies that this statement is executed for the purpose of inducing the Town of
Waierford to consider the statement of qualifications submitted herein.
State of Connecticut S.S.
County of 
arreyel
Subscribed and swom before me this_ 4st day of Asi | 
20.22.
Legal Name of Respondent: 
Bridnas Qeoio Worst
Business Name‘y, anno hes fhe Wsimon Constr
Business Address: 
YS Oircore S¥
LSridse (ck ~Ct Aeteorr
BLA 2—— - CED +framde, [Oene-
Signature and Title of Person
a 
My Commission Expires: 3 }31|2°24
ar
ANU 
Ds
Notary Public 
oSSBNNOS"y, 
Date: © YJ or) 2622]
bssGnin a oo 
perenne 
TS 
at 
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Non-Discrimination in Employment, During the performance of this Contract, the CONTRACTOR agrees
as follows:
The CONTRACTOR shall not discriminate against any employee or applicant for employment because of
race, creed, color, sex or national origin. The CONTRACTOR shall take affirmative action to insure that
applicants are employed and that employees are treated during employment without regard to their race,
creed, color, sex, or national origin. 
Such action shall include, but not be limited to, the following:
employment, upgrading, demotion, transfer, recruiting or recruitment advertising, layoff, termination, rates of
pay or other forms of compensation, and selection for training including apprenticeship. The CONTRACTOR
agrees to post in conspicuous places available to employees and applicants for employment notices to be
provided, setting forth the provisions of this Non-Discrimination in Employment Clause.
he
122.

AFFIRMATIVE ACTION/EQUAL EMPLOYMENT ACTIVITIES
Please indicate the name and address of the company official(s) responsible for carrying out the
’ Equal Employment Opportunity/Affirmative Action Program for your company.
1S Once St fy CE Oecpot
If your company does not have a written affirmative action plan, please estimate the number of
vacancies during the next 12 months, and indicate the numerical or percentage goals you have
set for the employment of minority people and females to make your labor force reflective of the
labor market in which you operate.
No vee nesses Ort Camcsgoced Cine, Ve nore 12 ren 
- Gwe,
1 
ag
On Crtirte 
+ fuwe Canticetors.
The vendor/bidder understands that failure to complete the above form in a satisfactory manner will
preclude such vendor from being actively considered for contract with the Town of Waterford. The
vendor /bidder also understands that the Affirmative Action statements will become part of any
contract, and that breach of such statements will constitute a breach of the contract subject to such
Temedies as provided by law. 
.
| certify that there are no misrepresentations, omissions, or falsifications in the foregoing statements
and answers, and that the entries above are true, complete, and correct to the best of my knowledge
and belief.
Date 4ltlioer 
Signature Aly 2m _ Title,
Qo
Subscribed and sworn to before me at. fez’ i ceiel 
Connecticut,
this Ast 
payof__ 
Ares)

AFFIRMATIVE ACTION STATEMENT
IF YOUR COMPANY HAS LESS THAN 10 EMPLOYEES, OR HAS COMPLETED
THIS SAME FORM WITHIN 1 YEAR, YOU MAY DISREGARD THE FOLLOWING
EQUAL EMPLOYMENT/AFFIRMATIVE ACTION SECTION, EXCEPT AS
NOTED.OR: (1) 
The number of employees ©
Completed this form within one year. 
Yes No
FOR SEALED BIDS: If your company has completed this form within one
Please forward a photocopy of the initial form with your bid. If significant Changes have taken place within
the past year, please update the information on this form.
REQUIREMENT ~ Any vendor/bidder seeking to do business with the Town of Waterford must, upon
Tequest, supply the Town with any information concerning the Affirmative Action/Equal Employment
practices of the vendor/bidder, which the Town and/or Commission deems necessary in fulfilling its charge.
Failure fo supply such information, when requested, will result in the termination of any further transactions
between the vendor/bidder and the Town of Waterford.
COMPANY NAME AND ADDRESS
Be 
y
TYPE OF
BUSINESS
Mlb 
ce sone
TYPE OF ORGANIZATION
Corporatio 
Partnership 
Individual _
amma

{f unit filing this application is not the above-named company, give the name, address, and
telephone number of reporting unit. (Branch, agent, representative).
Employment of Certain Persons Prohibited. No person under the age of sixteen years and
No person who at the time is serving sentence in a penal or correctional institution shall be
employed on the work covered by this Contract.
senor?

COMPLETE AND RETURN
BIDE 272-1200
BID TITLECe ssn, Soprtty,
You are required to furnish the following information to the Town of Waterford:
Name and address of Company 
DA bane We parte Visi contr Carn su\iing
(Print 
or type) [Loo o-Peage Ac. Meek Su vata
boot 020%
Name and Title of Agent of Company 
Bern nna. Qefrer, Wd sper,
(Print or type} 
Oumer 4 Cab Founde—
Signature 73. ae 
Date: Y| Nee
Telephone: “22% - $2.9 2.914 
Email: Bilanmec\ocvisioncry
CDSS’MTS CO
Fax: 
Federal ID. Number: 
°2-- 3 
G94;

2/9/22, 9:38 AM 
hups://biznet.ct.gov/SDSearch/Certificate 
aspx ?recno=47 155
State of Connecticut
Department of Administrative Services
Supplier Diversity Program
This Certifies 
Brianna Régine Visionary Consulting, LLC
1000 Lafayette Blvd Bridgeport CT 06604
Black American Woman Owned
Asa 
Small/Minority Business Enterprise
February 09,2022 through February 09,2024
Owner(s}: 
Branea Regine Waiston
Contact: 
Brianna Regine Walston 
Telephone: 
(£75).999-437 1 Ext: 
FAX;
E-Mail: 
brianna 
# brvisionarveonsulting 
com 
Web Address: 
www.brvisionaryconsulting.com
Affiliate Contpanies:
My, fealsifily 
LELJED
Supplier Diversity Director 
Supplier Diversity Specialist
2 A contractor awatiled a contract oF 8 portion of a comaut ander the set-asidy program shall nat subcontract witht any peeson{s) with Wham the comraetor is abtiliated.
hutps://biznet.ct.gov/SDSearch/ Certificate aspx ?recno=47 [55

FINANCE DEPARTMENT
Memo
April 7, 2022
Mr. Rob Brule
First Selectman
Town of Waterford
15 Rope Ferry Road
Waterford, CT 06385
Re: Bid Award — BID#22-117 Jordan Fire Services Electrical Upgrades
Dear Mr, Brule,
On March 9" 2022, bids were opened for the above mentioned project by the Fire Services
Director, Administrative Assistant and I with the attached results.
The Purchasing Agent on behalf of the Fire Services Department, recommends the contract for
this project be awarded to the lowest responsible bidder Stula Enterprises LLC. 
in the amount of
$11,487.00,
Purchasing Agent,
Town of Waterford

Office of the Director
Waterford Fire Department
204 Boston Post Road
Waterford CT. 06385
Director Fire Services 
Telephone: 860-440-0544
Michael J. Howley 
Facsimile: 860-444-5894
mhowley@waterfordct.org 
Cell: 860-235-0888
04/06/22
TO: Rawle Dummett
Re: Jordan Electrical Upgrade
Rawle, after reviewing the contract bids and meeting with you, the low bidder Stula Enterprises
LLC. and the Utility Commission on site Tuesday April 5" reviewing the scope of work, I feel
confident in awarding this project to the low bidder Stula Ent.
Any questions please feel free to contact me.
Director, Waterford Fire Services
Michael J. Howley

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FIFTEEN ROPE FERRY ROAD. 
WATERFORD, CT 06385-2896
Town of Waterford
Board ofSelectmen. 
ee 
at
“Request for Proposals
Jordan Fire Department Electrical Upgrades
Bid form RFP #22-117
The Purchasing Agent will accept Proposals until 10:00 am 28 February 2022 from
qualified firms at 15 Rope Ferry Road Waterford, CT. .
Firm Name: Orda Geeotes LLO 
¥ Al Materalg 
incldirg
r 
2 
nes Socket Ceotrcemiy
Address: 
3G, 
Wawacug 
Will Qh. 
in Sbok K
Nofwich CT O40
Material Cost: §_ 7300
Labor Cost:$ 
— 41677
Total Cost:$ 
(4, U%7
Written: Glevan thousand four handred ERs 
n_ 
Dollars
fH
Subscribed and sworn to before me this 
day af
oat *
= 34 i 22 
By: Sy Me
= te
y 
a 
eS
' 
Notary wile 
AAD FLAG WA 
Print Name: 
Shawn Shaler
a ~ *
“My Com misSion Expires: 
Title: 
Owned
” 
- 
ac 
atthe
. 
Linda D Flugrad
Notary Public-Connecticut
. 
My Commission Expires
2\Page 
— a 
20523-57754

IFTEEN ROPE FERRY ROAD 
WATERFORD, 
CT 06385-2886
TOWN OF WATERFORD
NON-COLLUSION STATEMENT
“The undersigned affirms that they are duly authorized to execute this contract, that this company,
corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder,
and that the contents of this bid as to prices, terms or conditions of said bid have not been communicated
by the undersigned nor by any employee or agent to any other person engaged in this type of business
prior to the official opening of this bid.”
We understand that this proposal must be signed by an authorized agent of our company to constitute a
valid proposal,
Date: 
3 | $far
Name of Company: 
Shula, Erkup 6525 Lic
Name and Title of Agent: 
Shaun Stule, 
Owrel
By (SIGNATURE): 
Me GE
Address: 
362 
Waweevs bil Rad Noroich 
Ct.
Telephone Number: 
460-634 ~(35|
9] Page 
20523-57752

CONTRACTOR INFORMATION SHEETS
(These sheets must be completed and included with Bid)
COMPANY NAME: 
8% Studs Enteriprires, ie
ADDRESS:_34. 6 IWOweenS 
Wi BA. 
— Nocwich CA, 06360
ESTABLISHED: _ 12. /3015
(Month) (Year). 
a
PE OF ORGANIZATION: (Circle One)
Cardia
B) Partnership
C) Corporation
D) Joint Venture
£) Other
(Specify)
{if Applicable)
FORMER FIRM NAME(S) YEARS IN BUSINESS
YEARS OF WORK IN A RELATED FIELD: 
| U
(Described Any Related Work)
Aled 
£2 - A 
OeanticAls 
in 
o0% 
vs
worked in 
Wa 
Ciedd 
over 
Aine
EQUIPMENT AND EMPLOYEES:
Provide a list (attached to this sheet} of equipment and employees anticipated to be utilized for this
work.
Shown Shut -Owrer ont E) 
holdv
Terk —_ Shovets_- Agpentic®
USE OF SUBCONTRACTORS:
To provide all the services listed in the specifications, would any services be handled by
Nore,
10[| Page 
20523-57751

subcontractors? NO 
Yes/No If “Yes”, please explain:
Subcontractor Name(s):
PROIECT MANAGER: Shawn Sto
11] Page
20523-57751

COMPLETE AND RETURN
Bid#:
Bid TITLE:
NON-CONFLICT AFFIDAVIT OF RESPONDENTS
Na Elected or Appainted Official, S8C member or other officer or employee or person whose salary is
payable In whole or in part from the Town of Waterford OR Beard of Education, nor any. immediate
family member thereof, is directly of indiractly interested in the Bid/Proposal, or in the supplies,
materials, equipment, work or labor 
to which It relates, or in any profits thereof.
The undersigned further certifies that this statement Is executed for the purpose of inducing the Town
of Waterford to consider the statement of qualifications submitted herein.
State of Connecticut 5.5.
County of 
ci)
Subscribed and sworn before me this NA 
day of 
Kadirmerriy 
, 20.dX
Legal Name of Respondent: 
Shown 
Stele,
Business Name: Skule 
Grterer’goq LLC
Business Address: 
er Wawecins 
Lill Rae
Morwich 
¢}h, 
O63f0
br pe Quire
Signature and Title of Person
By: Naracaen.&, Miho 
My Commission Expires:
Notary Public == JESSICA F. MICHAUD 
Date: 212512022,
NOTARY PUBLIC
MY COMMISSION EXPIRES APR, 26, 2024
20523-57751

Non-Diserimination_in_Employment, 
During the performance 
of this Contract, the
CONTRACTOR agrees as follows:
The CONTRACTOR shall not discriminate against any employee or applicant for employment
because of race, creed, color, sex or national origin. The CONTRACTOR shail take affirmative
action to insure that applicants are employed and that employees are treated during
employment without regard to their race, creed, color, sex, or national origin. Such action shall
include, but not be limited to, the following: 
employment, upgrading, demotion, transfer,
recruiting or recruitment advertising, layoff, termination, rates of pay or other forms of
compensation, and selection far training including apprenticeship. The CONTRACTOR agrees to
post in conspicuous places available to employees and applicants for employment notices to be
provided, setting forth the provisions of this Non-Discrimination in Employment Clause.
13| Page 
__ 
“20523-57751

AFFIRMATIVE ACTION/EQUAL EMPLOYMENT ACTIVITIES
Please indicate the name and address of the company official(s) responsible for carrying out the
Equal Employment Opportunity/Affirmative Action Program for your company.
Company 
Yas 
e565 
thon 
10 
Employers 
<0 
we, 
do
Do hove, 
on 
at rimative, 
action 
flan
\f your company does not have a written affirmative action plan, please estimate the number
of vacancies during the next 12 months, and indicate the numerical or percentage goals you
have set for the employment of minority people and females to make your labor force
reflective of the labor market in which you operate.
Inet, 
Blen 
On ovis ‘om Openings
The vendor/bidder understands that failure to complete the above form Ina satisfactory manner
will preclude such vendor from being actively considered for contract with the Town of
Watertord. The vendor /bidder also understands that the Affirmative Action statements will
become part of any contract, and that breach of such statements will constitute a breach of the
contract subject to such remedies as provided by law.
| certify that there are no misrepresentations, omissions, or falsifications in the foregoing
statements and answers, and that the entries above are true, complete, and correct to the best of
my knowledge and belief.
Date. / r5/ ww 
Signature Ww, Q- 
Title_OQure/H
Subscribed and sworn to before me at_(3 \ LStonbur yConnecticut,
this 25** payor Felprocac, 
2022,
20523-57751

AFFIRMATIVE ACTION STATEMENT
NOTE: 
IF YOUR COMPANY HAS LESS THAN 10 EMPLOYEES, OR HAS COMPLETED THIS
SAME FORM WITHIN 1 YEAR, YOU MAY DISREGARD THE FOLLOWING EQUAL
EMPLOYMENT/AFFIRMATIVE ACTION SECT! 1ON, EXCEPT AS NOTED.
OR: 
(1) 
The number of employees 
A
Compieted this form within one year. 
Yes 
x No
a
15(Page 
: 
“20523-57751.

FOR SEALED BIDS: If your company has completed this form within one
Please forward a photocopy of the initial form with your bid. If significant Changes have taken place
within the past year, please update the Information on this form.
REQUIREMENT 
~ Any vendaor/bidder seeking to do business with the Town of Waterford Must,
upon request, supply the Town with any Information concerning the Affirmative Action/Equal
Employment practices of the vendor/bidder, which the Town and/or Commission deems necessary
in fulfilling its charge. Failure to supply such information, when requested, will result in the
termination of any further transactions between the vendor/bidder and the Town of Waterford.
COMPANY. NAME AND ADDRESS
Shula Goteraniges ULC.
TYPE OF BUSINESS
Cleckrical pCorseuchion 
Ex coverion
TYPE OF ORGANIZATION
Corporation, 
Partnership. 
(raids) LLC
If unit filing this application is not the above-named company, give the name,.address, and
telephone number of reparting unit. (Branch, agent, representative).
Employment of Certain Persons Prohibited. No person under the age of sixteen years and no person
who at the time is serving sentence in a penal or correctional institution shall be employed on the
work covered by this Contract, 
,
16|Page 
. 
20523-57751

COMPLETE AND RETURN
BID#
BID TITLE
You are required to furnish the following Information ta the Town of Waterford:
Name and address of Company 
Que € shelprise5 tLe
(Print or type)
7 te 
362°" Wowecns KI RAT
Norwich 
Cl. 
06366
Name and Title of Agent of Company Shawn 
Shulo 
Ov pe/
(Print or type) 
;
Signature: Ox Le 
Date: 9 l % / 24
Telephone: Q66 -G 39-135) 
Email: Brcan(Y) SlelLL.Com
Fax: 
2€0-343-2426 
Federal iD. Number: 4 7- 534464)
17| Page 
20523-57751

Form W-9 
Request for Taxpayer 
Give Farm to tho
h 
7 
requester, Do not
Rw danay 2034) 
identification Number and Certification 
send 
to the IRS,
Name 
(85 shovn on your Tneome tax elu) 
:
Ow 
Spubey
Business names 
jared entity name, if diferent from above
reales carb ISLS
‘Check appropiate box for fe 
tax
slassifention (requted); JR) individuaeale propristor 
[] CCemporation 
[1 Scomaraton 
[1] Partnership CO trusvestate
Unites tapiaty company. Enter tha tax classification (C=C corporation, 
SeS corporation, Pepartnerahip) _ 
{Ci Exemat rayeo
C7 other (son instructions) >
Address (number, street, and apt. or sulle no) 
-Requester’s nama and address (optional),
Awecus 
Wil) 
(Rd.
Cilf 
tate, and ZIP code
Worwie, 
CT 
046360
st decounk numbsto) hers {optional
Print 
or typs
‘See 
Specific 
instructions 
on 
paga 
2.
‘Nake 
__~ Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name ‘given onthe “Name” line {| Soctal eeeurity number
to avold backup withholding, For Individuals, thia is your social seourity number (SSN). However, fora
resident atien, sole propriator, or dlaregarded entity, see the Part} Inatructiong on page 9. For other 
“| 
-
entities, It is your employar identification number (E)N). 
you do not have a number, sea How to geta
TIN on page 3.
Note. 
if the account Is in more than one nama, see the chart on page 4 far guidelines 
on whose 
| Emplayor identiication number
number to enter. 
é 
7
MAPA} 
[SI8 FY} S16 
(4
Certification
Under penalties of perfury, | certify that:
1. The number shown on this form is my correct taxpayer identification number (oy | am waiting fer a number to be Issued to me), and
2. Lar not subject (o backup withholding because: (a}i am exempt from backup withholding, or (0) | Have not been notified by the Intemal Revenue
Service (AS) that 1 am subject to backup withhofding as a-result of a falure to report ail interest or dividands, or (¢) the IAS has notified me that iam
nojonger subject to backup withholding, and
& [amal,S. cttizea 
ar ather U.S. parson (defined below},
Certification instructions, You must cross out item 
2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you hava failed to report 
all Interest and dividends on yéur tax retum. For real estate transactions, item 2 does not apply, For mortgage
interest pald, acquisitiod or abandonment of secured property, cancellation af debt, contributions to an Individual rallrament arrangement 
(RA), and
Benerelly, paymarita other than lnterest and dividends, you ara net raquired to sign the certification, but: you must provide your correct TIN, See the
Iona on page 
4,
Hore 
[Stems On Op 
mar 
S/g/aa
General instructions 
Nate. if a requester gives you a form ather than Farm W-9 to request
: 
ur TIN, 
Must 
use tha 
1 
ffl 
wally 
si
Séetion-refersnces ara to tha intamial Reventte Gade unless otherwise 
tous rows. tse 
the requestera fon It is substantaly sinar
noted. 
Definition of 
a U.S. person. For federal 
tax purposes, you are
Purpose of Form 
considered a U.S, person if you arez
parson 
wha ts required to file an information retum with the IRS mua? 
© An indhidual who is a U.S. elfen or U.S, resident alien,
cbtaln your correct taxpayer Identification number (MN) to report, for 
° Aparinership, comoration, company, or assnclation created or
example, income paid 
to you, raat estate transactions, mortgage interest 
organized in tha United States or under the laws of the United States,
you paid, ecquisition or abandonment of secured property, cancellation 
'
‘of debt, or contributions you made to an IRA. 
° An estate (other than a foreign estate), or
Use Form W-8 only you are a U.8, person (including # resident 
* Adomestic trust (as defined in Regulations section 301.7701-7).
allen);.to provide your cumrect TIN {0 the person requesting it (he 
Special rules for pernerships, Partnerships that conduct a trade or
requester) and; when applicable, to: 
business In the United States are generally requited to pay a withholding
'
1, Cestity that the TIN you are giving fs carreot (or you are waiting for a 
Aner een partner share ot la Be ea auch business, a
number to be issued), 
Partnership {s required to presume that a partner is a foreign person,
2, Cartify 
that you are not subject ta backup withholding, or 
and bay the wilbhalding: fax Theretare, ityou are a Wa. ‘Paeon rat isa,
5S. Clalm exemption from backup withholding Ifyou are aU.S.exempt 
partner In a partnership conducting a trade or business in the Un
Payee, if applicable, you are also exttving that asa U.S. person, your 
States, provide Form W-S to the partnership to establish your US.
alfocable share of any partnership Income from a U.S, trade or business 
status and avoid withholding on your share of partnership income.
is net subject to the withholding tax an foreign partners’ share of
effectively connected income,
Gat, No. 10291X 
Form WY-9 Rev, 4-209)
23

FINANCE DEPARTMENT
Memo
April 7, 2022
Mr. Rob Brule
First Selectman
Town of Waterford
15 Rope Ferry Road
Waterford, CT 06385
Re: Bid Award — BID#22-117 Jordan Fire Services Electrical Upgrades
Dear Mr, Brule,
On March 9" 2022, bids were opened for the above mentioned project by the Fire Services
Director, Administrative Assistant and J with the attached results.
The Purchasing Agent on behalf of the Fire Services Department, recommends the contract for
this project be awarded to the lowest responsible bidder Stula Enterprises LLC.in the amount of
$11,487.00,
pom
LEMFLEE 
DR
Purchasing Agent,
Town of Waterford

SN
Office of the Director
Waterford Fire Department
204 Boston Post Road
Waterford CT. 06385
Director Fire Services 
Telephone: 860-440-0544
Michael J. Howley 
Facsimile: 860-444-5894
mhowley@waterfordct.org 
Cell: 860-235-0888
04/06/22
TO: Rawle Dummett
Re: Jordan Electrical Upgrade
Rawle, after reviewing the contract bids and meeting with you, the low bidder Stula Enterprises
LLC. and the Utility Commission on site Tuesday April 5"° reviewing the scope of work, I feel
confident in awarding this project to the low bidder Stula Ent.
Any questions please feel free to contact me.
Director, Waterford Fire Services
Michael J. Howley

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DIG

FIFTEEN ROPE FERRY ROAD 
WATERFORD, CT 06385-2886
Town of Waterford
Request for Proposals
Jordan Fire Department Electrical Upgrades
Bid form RFP #22-117
The Purchasing Agent will accept Proposals until 10:00 am 28 February 2022 from
qualified firms at 15 Rope Ferry Road Waterford, CT. .
: 
- 
aterals 
inched
Firm Name: Ban Crketotaes LLC 
KAM materials 
including
meric 
Socket 
Gotcentiy
Address: 
oN 
Wh 
QA. 
. 
re
Novus 
30 
in Stock ¥
Material Cost:§ 7300
Labor Cost:§ 
4167)
Total Cost: $ 
iN, 447
Written: Gleven Snousgard kowr handred Gifts Seven, 
Dollars
fhe
Subscribed and sworn to before me this 
day of
: Notary wai 
AAD Fe le ipta- 
Print Name: 
Shown Chala
5
“My Commission Expires: 
Title: 
Qwret
“ies
Dy
ya
ye
. 
Linda D Flugrad
Notary Public-Connectiout
My Commiseton Expires
April30, 2026
2|Page 
20523-57754


FIFTERN ROPR FERRY ROAD 
WATERFORD, 
Ct’ 06385-2886.
TOWN OF WATERFORD
NON-COLLUSION STATEMENT
“The undersigned affirms that they are duly authorized to execute this contract, that this company,
corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder,
and that the contents of this bid as to prices, terms or conditions of said bid have not been communicated
by the undersigned nor by any employee or agent to any other person engaged in this type of business
prior to the official opening of this bid.”
We understand that this proposal must be signed by an authorized agent of our company to constitute a
valid proposal.
Date: 
a % } aX
Name of Company: 
Shule, Eng r6e5 LLC
Name and Title of Agent: 
Shaun S 
le 
OW
tu 
ref
By (SIGNATURE): 
Qe
wr 
7
Address: 
FER aes WA RA. Norwich Ct.
Telephone Number: 
Léo-6 34-135 |
9|Page 
20523-57752

CONTRACTOR INFORMATION SHEETS
(These sheets must be completed and included with Bid)
COMPANY NAME: 
_% 
Shula Enterpriheg 
\VC
ADDRESS: 33. 6 LWwowecns 
bit! @d. 
Nace CA. 06360
ESTABLISHED: (a hoiS
(Month) (Year).
PE OF ORGANIZATION: (Circle One)
Capndvidua 
.
B) Partnership
C) Corporation
D) Joint Venture
E) Other
(Specify)
(if Applicable)
FORMER FIRM NAME(S) YEARS IN BUSINESS
YEARS OF WORK IN A RELATED FIELD: 
| UY
(Described Any Related Work)
T__gtled 
yay 
ove -ASeauticanig 
Tn 
HOO 
awd 
pee
wr ksd 
ta 
Me Geld 
over 
Aine
EQUIPMENT AND EMPLOYEES:
Provide a list (attached to this sheet) of equipment and employees anticipated to be utilized for this
work,
Shown Shula -Qwer ond El 
holly
Tet —_ Ghowets_- Aggarbice
USE OF SUBCONTRACTORS:
To provide all the services listed in the specifications, would any services be handled by
Nove,
4o|Page 
"20523- 57751

subcontractors? ty Q 
Yes/No If “Yes”, please explain:
Subcontractor Name(s):
PROIECT MANAGER: Shawn Stula
11 | Page
20523-57751

COMPLETE AND RETURN
Bid #:
Bid TITLE:
NON-CONFLICT AFFIDAVIT OF RESPONDENTS
No Elected or Appointed Offictal, SBC member or other officer or employee or person whose salary is
payable in whole or in part from the Town of Waterford OR Board of Education, nor any. immediate
family member thereof, is directly of indirectly interested in the Bid/Proposal, or in the supplies,
materials, equipment, work or labor to which It relates, or in any profits thereof.
The undersigned further certifies that this statement is executed for the purpose of Inducing the Town
of Waterford to consider the statement of qualifications submitted herein.
State of Connecticut $.S,
County of _ 
ow” 
ey
Subscribed and sworn before me this Wa 
day of __ Fabmnory 
,20d%
Legal Name of Respondent: 
Showy 
Shela,
Business Name:_ Stale 
Gubepriseg 
LLC
Business Address: 
Ora. 
Wawertsas iil Ra.
(Voewich 
Ch, O63£0 |
Be Dr 
Qwrer
Signature and Title of Person
By: Qosaciaen.&, MHirheww 
My Commission Expires:
JESSICA F. MICHAUD 
pate: 2/2512022.
NOTARY PUBLIC 
;
HY COMMISSION EXPIRES APR. 4, 2024
12, Page 
20523-57754

43 | Page
Non-Discrimination 
in 
Employment, 
During the 
performance 
of this Contract, the
CONTRACTOR agrees as follows:
The CONTRACTOR shall not discriminate against any employee or applicant for employment
because of race, creed, colar, sex or national origin. The CONTRACTOR shall take affirmative
action ta insure that applicants are employed and that employees are treated during
employment without regard to their race, creed, color, sex, or national origin. Such action shall
include, but not be limited to, the following: 
employment, upgrading, demotion, transfer,
recruiting or recruitment advertising, layoff, termination, rates of pay or other forms of
compensation, and selection for training including apprenticeship. The CONTRACTOR agrees to
post in conspicuous places available to employees and applicants for employment notices to be
provided, setting forth the provisions of this Non-Discrimination in Employment Clause.
20523-57754

AFFIRMATIVE ACTION/EQUAL EMPLOYMENT ACTIVITIES
Please indicate the name and address of the company official{s) responsible for carrying out the
Equal Employment Opportunity/Affirmative Action Program for your company.
Company 
Was 
1255 
thon 
{0 
Employers 
So 
we, 
46
Or ove 
ow 
—_ atrimakive, — arbion 
floo
{f your company does not have a written affirmative action pian, please estimate the number
of vacancies during the next 12 months, and indicate the numerical or percentage goals you
have set for the employment of minority people and females to make your tabor force
reflective of the labor market in which you operate,
Wwe, 
Plon 
On 
hovieg 
©) 
Ovanirge
fo 
. 
rene
The vendor/bidder understands that failure to complete the above form Ina satisfactory manner
will preclude such vendor from being actively considered for contract with the Town of
Waterford. The vendor /bidder also understands that the Affirmative Action statements will
become part of any contract, and that breach of such statements will constitute a breach of the
contract subject to such remedies as provided by law.
\ certify that there are no misrepresentations, omissions, or falsifications in the foregoing
statements and answers, and that the entries above are true, complete, and correct to the best of
my knowledge and belief.
Date \/ r5/ ESS 
Signature Ww A Title__QumeH
Subscribed and sworn to hefore me at_G \ LOtkoNbLA {yConnecticut,
this_25*h Day of fedrorse YW 
2022.
1a|Page 
ZZ 
: 
20523-57752

AFFIRMATIVE ACTION STATEMENT
NOTE: 
IF YOUR COMPANY HAS LESS THAN 10 EMPLOYEES, OR HAS COMPLETED THIS
Seen 
Ee EA 
ERD
SAME FORM WITHIN 1 YEAR, YOU MAY DISREGARD THE FOLLOWING EQUAL
EMPLOYMENT/AFFIRMATIVE ACTION SECT ION, EXCEPT AS NOTED,
OR: 
(1) 
The number of employees 
aA
Completed this form within one year 
Yes 
No
ws
15| Page 
20523-57751

FOR SEALED BIDS: If your company has completed this form within one
Please forward a photacopy of the initial form with your bid. If significant Changes have taken place
within the past year, please update the information on this form.
REQUIREMENT ~ Any vendor/bidder seeking to do business with the Town of Waterford must,
upon request, supply the Town with any information concerning the Affirmative Action/Ecqual
Employment practices of the vendor/bidder, which the Town and/or Commission deems necessary
in fulfilling Its charge. Failure to supply such information, when requested, will result in the
termination of any further transactions between the vendaor/bidder and the Town of Waterford.
COMPANY. NAME ANB ADDRESS
_ Khurtea Gotergrisey UC
TYPE OF BUSINESS
Clechrical, Congeuction , Cxcavedion
TYPE OF ORGANIZATION
Corporation, 
Partnership. 
Aindividual 
LLC
lf unit filing this application is not the above-named company, give the name,.address, and
telephone number of reporting unit. (Branch, agent, representative).
Employment of Certain Persons Prohibited. No person under the age of sixteen years and no person
who at the time is serving sentence in a penal or correctional institution shall be employed on the
work covered by this Contract. 
,
16) Page 
. 
2OSAA-S7752

COMPLETE AND RETURN
SIDH
BID TITLE
You are required to furnish the following information to the Town of Waterford:
Name and address of Company 
_Slula € ntelprs25 (Le
(Print or type)
_ 
362- Wowecws iN Ra
Norwich 
Ch. 
06360
Name and Title of Agent of Company Shawn 
Shula 
Ovnre/
(Print or type)
Signature: Oe Q- 
pate:__9/ 4/ 2A
Telephone: Zés -634-135) 
Email: Srosun(Cd DNublL.com
Fax: $€0-343-24IE 
Federal 1D. Number: “47-534 4647
17 |Page 
20523-57751

Rev, January 2011}
Department 
of the Treasury
intemal Revarun Service
Request for Taxpayer
identification Number and Certification
Give Farm ta the
raquester. Do not
send to the IRS.
‘Name (as shown on your Income tax rate)
QW rule
“eh, 
namee 
jerded ently nama, if diferent fram above
ule 
Gribee fi5L5
Check appropiate 
box for feddral tax
[7 otney (eon instructions) >
classiffeation (required); JR ingwiduaveo's propristor 
1] © Comoration
(2) Limtod itabttty company, Enter the tax classiication (O=C porporation, 8-3 corporation, Paparinership)>
C] Scororation 
[1] Partnership [1] trusvestate
ID Exempt payee
Address (number, stregt, andapt. or suite no)
AWECAS 
nil) ad.
Requestera nama and address (optional,
City, state, and 28 code
Wofwi. 
CT 06360
Print 
or type
See 
Specific 
Instructions 
on 
page 
2.
Ust eccount number(s} here (optional)
< 
oe
BP 
| _~ Taxpayer identification Number (riN}
Enter your TIN {n the appropriate box. The TIN provided must match-the name given on the “Name” [ne
fo avoid backup withholding, For Individuals, this is your social eecurity number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, seo the Part I Instuetiona on page 3, For other 
bal 
~
entitles, Itis your employer identification number (EIN). Ityou da not have a number, see How to geta
TIN on paga 3,
Note. if the account [s in more than one name, see the chart 
on page 4 for guidelines on whose
number to enter.
Social aacurity number:
Certification
Under penalties of perfury, | certity that:
1.. The number shown on this form Is my correct ‘taxpayer Identification number (or | am walting for a number to be Issued to me), and
2. Lam not subject to backup withholding because: (a)! am exempt fram backup withholding, or @) ( have tot been notified by the Internal Revenue
‘Sarvice (19S) that) am subjact to backup withholding as @-result of a fallura to report alt Interest or dividands, or {c} the IAS has notified mia that J am
ho longer subject to backup withhelding, and
4. 
[ama U,S. citizen or other U.S, parson (defined below).
Certification instructions, You must cross out Item 2 above if you have been notified by the (RG that you are currently subject to backup withholding
because you hava faited to report all Interest and dividenda on your tax retum. Far teal estate transactions, item 2 does not apply. For. morgage
interest paid, acquisition or abandonment 
of secured property, cancellation af debt, contributions to an fndividual retirement arrangement (RA), and
generally, paymerits other than interest and dividends, you are not Taquirad 
to eign the cerlification, but you must provide your correct TIN. See the
instructions on page 4.
Sian’) 
signature ot 
On
Here | us person> On 
Dute > 
S/¢/ra
General Instructions 
Note. if a requester gives youa form other than Fort W-8 to request
Séction.roferances ara to the Intamal Revenue Cade unless othanwise
noted,
Purpose of Form
A parson wha ia required ta file an Information retum with the IRS must
obtaln your comect taxpayer identification number {TIN} to report, for
exampie, incoma paid to you, real estate transantions, mortgage interest
you paid, ecquisition or abandonment of secured property, cancellation
‘of debt, pr contributions you made te an IRA.
Use Form W-9 only # you are a U.S, parson {neluding a resident
affen);.to provide your correct TIN to the person requesting if (he
vequester) and; when appicable, ta:
1, Certity that the TIN you are giving fs correct (or you are waiting tora
number to be issued),
2, Certify 
that you are not subject ta backup withhalding, or
3. Claim exemption fom backup withholding if you are a U.S: exempt
payee. if applicable, you are also certifying that a3 a U.S. person, your
allocable share of any partnership Incema from a U.S, trade or: ‘business
is nat subject to the withh¢lding fax an forelgn partners’ share of
@ffectively connected income.
your TIN, you must uge tha requester's form ifltis substanilally similar
to this Form W-9.
Definition of 
a U.S. parson, For federal tax purpesas, you aro
considered a U.S, person Hf you are:
© An individual who (3 a U.S, citizen or U.S, resident alten,
® Apartnership, corporation, company, or assaciation created or
organized In the United States or under the faws of the United States,
9 An estate {other than a forelyn estate), or
* Adomestic trust (as defined In Regulations section 301,7701-7}.
Special nites for pertnerships. Partnarehips that conduct atrade or
business In tho United States are generally required ta pay a withholding
tax 
on any foreign partners’ share of income from auch business,
Further, in certain cases where a Form W-8 has not been recelved, a.
Parnership is required to presume that 
a pariner 8 a foreign person,
and pay the withhotging tax, Therefore, Ifyou are a U.S. person that is a
partner In a partnership conducting a trade of business in the United
States, provide Form W-8 to the partnership to establish your U.S,
‘Statue and avoid withholding on your share of partnarshig inate.
Gat, No. 10231K
Form W-9 aw, 1-204]
23

FIFTEEN ROPE FERRY ROAD 
WATERFORD, CT 06385-2886
DEPARTMENT OF PLANNING AND DEVELOPMENT
MEMORANDUM
TO: 
Rob Brule, First Selectman
FROM: 
Abby Y. Piersall, AICP, Planning Director
DATE: 
March 31, 2022
TITLE: 
Additional Appropriation Request for the Building Department Budget
This request is for an appropriation to the Building Department budget. The appropriation is requested in
response to the retirem