CASL for sole proprietor~14.pdf
PDF 195 KB Posted
- Attached to
- FY2027 DCR Watershed System Salt Reduction Grant
- Solicitation number
- BD-27-1020-DCRCU-DC250-133000
- Issued by
- Worcester County, Massachusetts
About this file
This document is a Contractor Authorized Signatory Form jointly issued by the Commonwealth of Massachusetts Office of the Comptroller and the Operational Services Division. The form is designed for use by all Commonwealth Departments as the default authorization document when another form is not prescribed by regulation or policy. The form serves as the official vehicle for establishing notarized signatures of authorized individuals—whether contractors, sole proprietors, or individuals—who are empowered to execute contracts and other legally binding documents on behalf of a contractor. The form requires that the signatory's signature be provided in ink on paper in the presence of a notary public, and must match the contractor's Form W-9 tax classification. A completed copy of the form must be attached to the record copy of any contract filed with the relevant Commonwealth department.
The form emphasizes strict privacy protections by explicitly prohibiting the attachment of documentation containing personal information such as bank account numbers, Social Security numbers, driver's licenses, home addresses, or other personally identifiable information that would otherwise be subject to public disclosure. The Commonwealth reserves the right to publish the names and titles of authorized signatories of contractors. The form includes sections for the contractor's legal name, vendor or customer code, the authorized signatory's full legal name and title, notary public certification with commission expiration date, and notary seal or stamp affixation. This standardized form applies to the FY2027 DCR Watershed System Salt Reduction Grant administered by the Massachusetts Department of Conservation and Recreation, Division of Water Supply Protection.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CASL for CORPS~13.pdf | ||
| Standard Contract Form new~7.pdf | ||
| DCR 2027 Salt Reduction Grants RFR.pdf | ||
| FY27-DCR-Watershed-Work-Plan-Budget-Summary.pdf | ||
| W-9 Form~3.pdf | ||
| DCR 2027 Salt Reduction Grant Application Template.docx | DOCX document | |
| EFT Form 2024~10.pdf |
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Text version
Commonwealth of Massachusetts
CONTRACTOR AUTHORIZED SIGNATORY FORM
This form is jointly issued and published by the Office of the Comptroller (CTR) and the Operational Services Division (OSD) as the default form for all Commonwealth Departments when another form is not prescribed by regulation or policy.
Notarized Signature for Individual, Sole-Proprietor or Single Member LLC (must match Form W-9 tax classification)
Contractor Legal Name Contractor Vendor/Customer Code (if available, not the Taxpayer Identification Number)
INSTRUCTIONS: Any Contractor, sole-proprietor, or an individual, must provide a notarized signature of the authorized person who can sign contracts and other legally binding documents related to the contract on the Contractor’s behalf.
For privacy purposes DO NOT ATTACH any documentation containing personal information, such as bank account numbers, social security numbers, driver’s licenses, home addresses, social security cards or any other personally identifiable information that you do not want released as part of a public record. The Commonwealth reserves the right to publish the names and titles of authorized signatories of contractors.
Signature (ink on paper) Contractor Signature as it will appear on contract or other documents (Complete only in presence of notary)
Print Signatory’s full legal name Title
Certificate of Acknowledgement of Notary Public Before me, the undersigned notary public, the above named individual proved to me through satisfactory evidence of identification, to be the person whose name is signed above and acknowledged to me that (he)/(she) signed for its stated purpose.
Print Notary Name Notary Signature (ink on paper)
Date My commission expires on
AFFIX NOTARY SEAL/STAMP
A copy of this document must be attached to the “record copy” of a contract filed with the department.
| Notarized Signature for Individual, Sole-Proprietor or Single Member LLC |
| (must match Form W-9 tax classification) |
| Contractor Legal Name: |
| Print Signatorys full legal name: |
| Title: |
| Print Notary Name: |
| Date: |
| My commission expires on: |
| Contractor Vendor/Customer Code: |
File details come from the government source that posted it. Updated .