CASL Form for Sole Proprietors.pdf
PDF 220 KB Posted
- Solicitation number
- BD-26-1046-DFW-FWE11-128187
- Issued by
- Massachusetts
About this file
The Contractor Authorized Signatory Listing (CASL) Form is jointly issued by the Commonwealth of Massachusetts Office of the Comptroller and the Operational Services Division as the default authorization document for all Commonwealth departments absent other prescribed regulations or policies. This form is applicable to the Massachusetts Division of Fisheries & Wildlife's Request for Response regarding the Salt Marsh Restoration Project, which involves final design and permitting work for 3,278 acres of salt marsh within Great Marsh. The CASL form serves as the required documentation for contractors, sole proprietors, and individuals to designate authorized signatories who may execute contracts and legally binding documents on the contractor's behalf in connection with Commonwealth contract opportunities.
The CASL form requires a notarized signature from the authorized individual, with the signature and signatory information matching the contractor's Form W-9 tax classification. Contractors must provide the contractor legal name, vendor/customer code if available, the authorized signatory's full legal name, title, and a notarized signature in ink on paper. The form includes a Certificate of Acknowledgement section completed by a notary public who verifies the signatory's identity and acknowledgment of the document's purpose. A copy of the completed and notarized CASL form must be attached to the record copy of any contract filed with the Commonwealth department. The form explicitly prohibits attachment of personally identifiable information such as bank account numbers, social security numbers, driver's licenses, or home addresses, as the Commonwealth reserves the right to publish the names and titles of authorized signatories as part of the public record.
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Commonwealth of Massachusetts
CONTRACTOR AUTHORIZED SIGNATORY LISTING (CASL) 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.
| Commonwealth of Massachusetts |
| CONTRACTOR AUTHORIZED SIGNATORY FORM |
| Contractor Legal Name: |
| Print Signatorys full legal name: |
| Title: |
| Date: |
| My commission expires on: |
| Contractor Vendor/Customer Code: |
| Print Notary Name: |
| AFFIX NOTARY SEAL/STAMP: |
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