form_contractor-authorized-signatory-listing-for-sole-proprietors.pdf
PDF 195 KB Posted
- Solicitation number
- BD-25-1067-MCD01-MCD01-113447
- Issued by
- Suffolk County, Massachusetts
About this file
This document is a Contractor Authorized Signatory Form issued jointly by the Commonwealth of Massachusetts' Office of the Comptroller (CTR) and the Operational Services Division (OSD). The form is a default template for Massachusetts state departments to capture authorized signatures for contracts and legally binding documents for sole proprietors, individuals, or single-member LLCs, ensuring that the signatory matches the tax classification on Form W-9.
The form requires a notarized signature from the authorized individual, with specific instructions to protect personal privacy by avoiding attachment of sensitive personal information. The Commonwealth reserves the right to publish the names and titles of authorized signatories. The document must be completed in the presence of a notary public, who will verify the signatory's identity and acknowledge the signature's purpose. A copy of this completed form must be attached to the record copy of the contract filed with the respective department.
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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 .