Fillable Office of access and opportunity AUTHORIZED SIGNATORY LISTING

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Office of access and opportunity AUTHORIZED SIGNATORY LISTING

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U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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One Ashburton Place, 15
th
Floor, Boston MA 01208 617.727.4050
AUTHORIZED SIGNATORY LISTING
INSTRUCTIONS: Any company applying for a Certificate of Eligibility with the Commonwealth of
Massachusetts Division of Capital Asset Management and Maintenance (“DCAMM”) must provide a
listing of individuals who are authorized as legal representatives of the company who can sign contracts,
applications and other legally binding documents on the company’s behalf.
AUTHORIZED SIGNATORY NAME
TITLE
I certify that I am the President, Chief Executive Officer, Chief Fiscal Officer, Corporate Clerk or Legal
Counsel for _______________________________________ and as an authorized officer of the company
I certify that the names of the individuals identified on this listing are current as of the date of execution
below and that these individuals are authorized to sign contracts, applications and other legally binding
documents related to contracts with the Commonwealth of Massachusetts on behalf of the company. I
understand and agree that the company has a duty to ensure that this listing is updated and communicated
to DCAMM for each application filed.
_____________________________________________ Date:
Signature
Title: Telephone:
Fax: Email:
The Office of Access & Opportunity
Contractor Certification Office
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Completed 20 February 2020

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