contractor-authorized-signatory-listing-sole-proprietors~43.pdf
PDF 195 KB Posted
- Attached to
- SP26-Crime Lab Temp-L01
- Solicitation number
- BD-26-1084-POLCL-FIMAY-126606
- Issued by
- Massachusetts
About this file
This is a Contractor Authorized Signatory Form jointly issued by the Commonwealth of Massachusetts Office of the Comptroller (CTR) and the Operational Services Division (OSD) for use across all state departments when no alternative form is prescribed by regulation or policy. The form is designed to capture notarized signatures from authorized representatives of contractors, sole proprietors, or single-member LLCs who are legally authorized to sign contracts and binding documents on behalf of the contractor. The form requires the contractor's legal name, vendor/customer code if available, the authorized signatory's full legal name and title, and an original ink signature executed in the presence of a notary public. A notary acknowledgement section certifies that the individual's identity was verified through satisfactory evidence and that the signature was executed voluntarily for the stated purpose, with the notary's signature, seal, and commission expiration date required.
The form serves as a critical component of the Commonwealth's contracting process and must be attached to the record copy of any executed contract filed with the relevant state department. Contractors are instructed not to attach any documentation containing sensitive personal information such as bank account numbers, social security numbers, driver's licenses, home addresses, or other personally identifiable information, as these documents may be released as part of the public record. The Commonwealth reserves the right to publish the names and titles of authorized signatories. The form includes duplicate sections to allow contractors to submit multiple authorized signatories if needed.
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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 .