21 S CASL.doc
DOC document 460 KB Posted
- Attached to
- SAFETY GRANT 2021
- Solicitation number
- BD-20-1043-DAO01-32500-52023
- Issued by
- Suffolk County, Boston City, Massachusetts
About this file
The provided document is a Contractor Authorized Signatory Listing (CASL) from the Executive Office of Labor and Workforce Development in Massachusetts. It requires the contractor to list the individuals authorized to sign contracts and other legally binding documents on the contractor's behalf. The contractor must also submit a separate Contractor Authorized Signature Verification Form. The Commonwealth reserves the right to publish the names and titles of the authorized signatories.
The related state and local contract opportunity is for a Safety Grant program designed to fund initiatives that reduce the risk of injury and illness to workers and promote safe and healthy workplaces through training, education, and other preventative measures. The grant is funded by the state of Massachusetts. No other details about the contract opportunity, such as response dates, award dates, or contract term, are provided in the given information.
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Text version
CONTRACTOR AUTHORIZED SIGNATORY LISTING (CASL)
Executive Office of Labor and Workforce Development
CONTRACTOR LEGAL NAME:
CONTRACTOR VENDOR/CUSTOMER CODE:
DBA (if applicable):
INSTRUCTIONS: All Contractors (other than a sole-proprietor or an individual contractor) must provide a listing of individuals who are authorized as legal representatives of the Contractor who are authorized to sign contracts and other legally binding documents on the Contractor’s behalf. In addition to this listing, additional proof of authority to sign contracts on behalf of the Contractor, and/or proof of authenticity of signature is required by Contractor’s submission of a completed Contractor Authorized Signature Verification Form (CASV).
NOTICE: Acceptance of any payment under a Contract or Grant shall operate as a waiver of any defense by the Contractor challenging the existence of a valid Contract due to an alleged lack of authority to execute the document by the signatory.
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.
| PRINT AUTHORIZED SIGNATORY’S NAME |
| TITLE |
I certify that I am the President, Chief Executive Officer, Chief Fiscal Officer, Corporate Clerk, Legal Counsel or other authorized officer of the Contractor. I hereby 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 and other legally binding documents related to contracts with the Commonwealth of Massachusetts on behalf of the Contractor. I understand and agree that the Contractor has a duty to ensure that this listing is immediately updated and communicated to any state department with which the Contractor does business whenever the authorized signatories are no longer authorized to sign contracts with the Commonwealth or whenever new signatories are designated.
Signature:
Date:
Print Name:
Title:
Telephone:
Fax:
Email:
[Listing cannot be accepted unless all of the information is completed. The Contractor must also complete and submit a Contractor Authorized Signature Verification Form (CASV), as appropriate.] EOLWD CASL revised 07-11
_1163939600.doc
File details come from the government source that posted it. Updated .