Form_contractor-authorized-signatory-listing-for-sole-proprietors_June_2025.pdf
PDF 190 KB Posted
- Solicitation number
- BD-27-1071-VR-VR00-131846
- 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 other form is prescribed by regulation or policy. The form is specifically designed for sole proprietors, individuals, and single-member LLCs to provide notarized authorization for individuals who are empowered to sign contracts and other legally binding documents on behalf of the contractor. The form requires the contractor's legal name, vendor/customer code, the authorized signatory's full legal name and title, an original ink signature from the authorized individual, and notarization by a qualified notary public. The notary must verify the signatory's identity through satisfactory evidence of identification and confirm that the individual signed the document voluntarily for the stated purpose.
Contractors submitting this form are explicitly instructed not to attach any documentation containing personally identifiable information, including bank account numbers, social security numbers, driver's licenses, home addresses, or social security cards, as such materials may be released as part of the public record. A copy of the completed, notarized form must be attached to the record copy of the contract filed with the appropriate Commonwealth department. The Commonwealth reserves the right to publish the names and titles of authorized signatories, and the form must align with the contractor's Form W-9 tax classification for sole proprietors and single-member LLCs.
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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 .