20 S CASV~1.pdf

Executive Office of Labor and Workforce Development

CONTRACTOR AUTHORIZED SIGNATURE VERIFICATION FORM

FOR CORPORATIONS ONLY

(DO NOT USE THIS FORM IF YOU ARE AN INDIVIDUAL, PARTNERSHIP, LLC OR OTHER ENTITY)

Grantee/Contractor Name:

DBA (if applicable):

Select either OPTION 1 or OPTION 2 to verify signature & authorization.

OPTION 1 CORPORATE SECRETARY/CLERK CERTIFICATION:

SIGNATORY: Complete and sign in the Signatory and Signature fields below, as applicable. (Signatory must be the same individual who signs the Commonwealth of Massachusetts Standard Contract Form.)

PRINT SIGNATORY'S NAME: ______________

SIGNATURE (as it will appear on all documents):

Complete and date the Corporate Secretary/Clerk section below:

The Corporate Secretary/Clerk may certify in the space below that they have witnessed the authorized signatory's signature (signed in the Secretary/Clerk’s presence) AND that the signatory is authorized to execute contracts and other documents and to legally bind the corporation. (NOTE: Secretary/Clerk may not self-certify if acting as both Secretary/Clerk and authorized signatory. In such case, please complete Option #2.)

(CORPORATE SECRETARY/CLERK) I, ________________________ (Print Name), __________________________ (Signature) as Corporate Secretary/Clerk of the Grantee/Contractor, certify under the pains and penalties of perjury that I witnessed the signature of the aforementioned signatory and the signatory is authorized to execute contracts and other instruments and legally bind the Grantee/Contractor. This date: __________________________, 20 _______.

OPTION 2 AUTHORIZATION AND OFFICIAL SAMPLE OF SIGNATURE OR NOTARIZATION:

SIGNATORY: Complete and sign in the Signatory and Signature fields below, as applicable. (Signatory must be the same individual who signs the Commonwealth of Massachusetts Standard Contract Form.)

Complete BOTH sections “a” and “b” below (and check appropriate boxes when completed):

a. Authorization. Attach documentation that states the signatory is authorized to execute contracts on behalf of and legally bind the corporation. Such documents may include, but are not limited to, a Board of Directors Vote, Certificate of Resolution or Minutes of a Meeting.

AND

b. Official Sample of Signature or Notarization.

Select one option:

Official Sample of Signature. Attach a copy of a driver's license, passport, business ID or other official form or identification containing the authorized signatory's signature, OR

Notarization. Have the signatory's signature notarized (signed in a notary's presence) below:

(NOTARY) I, __________________________________(Printed Name) ______________________________(Signature) as a notary public certify under the pains and penalties of perjury that I witnessed the signature of the aforementioned signatory on behalf of the Bidder/Grantee/Contractor , and the individual's identity was verified, on this date: ___________________, 20 _______. My commission expires on: __________________________, 20_______.

(Affix Notary Seal)

8/8/2011

Executive Office of Labor and Workforce Development

CONTRACTOR AUTHORIZED SIGNATURE VERIFICATION FORM

FOR INDIVIDUALS, PARTNERSHIPS, LLCS OR OTHER ENTITIES ONLY

(DO NOT USE THIS FORM IF YOU ARE A CORPORATION)

CHOOSE AND COMPLETE ONE TYPE OF ENTITY:

Bidder/Grantee/Contractor Name:

I. INDIVIDUALS - Individuals must complete and sign the Signatory and Signature fields as applicable and complete one of the two options below for verification of signature:

PRINT SIGNATORY'S NAME: _______________

PLEASE COMPLETE EITHER 1 OR 2 BELOW (and check appropriate box when completed):

1. Official Sample of Signature. Submit a copy of a driver's license, passport, business ID or other official form or identification containing the authorized signatory's signature.

OR

2. Notarization. Have the signatory’s signature notarized (signed in a notary’s presence) below.

(NOTARY) I, __________________________________(Printed Name) ______________________________(Signature) as a notary public certify under the pains and penalties of perjury that I witnessed the signature of the aforementioned signatory on behalf of the Bidder/Grantee/Contractor , and the individual's identity was verified, on this date: ___________________, 20 _______. My

II. PARTNERSHIPS, LLCs OR OTHER ENTITIES – Partnerships, LLCs or Other Entities must complete and sign the Signatory and Signature fields as applicable and provide/complete the information requested in 1 and 2 below:

PLEASE COMPLETE BOTH SECTIONS 1 AND 2 BELOW (and check appropriate boxes when completed):

1. Authorization to Sign Contracts. Attach documentation that states the signatory is authorized to execute contracts on behalf of and legally bind the partnership or other entity. Such documents may include, but are not limited to, a Partnership Agreement, Operating Agreement, or in the case of LLCs, authority from a manager as that term is defined in MGL c. 156C.

AND

2. Official Sample of Signature or Notarization:

Select one option:

a. Official Sample of Signature. Attach a copy of a driver's license, passport, business ID or other official form or identification containing the authorized signatory's signature; OR

b. Notarization. Have the signature notarized in the space below.

(NOTARY) I, __________________________________(Printed Name) ______________________________(Signature) as a notary public certify under the pains and penalties of perjury that I witnessed the signature of the aforementioned signatory on behalf of the Bidder/Grantee/Contractor, and the individual's identity was verified, on this date: ___________________, 20 _______. My

8/8/2011