commbuys.casl.form.sole.prop.update.6.25.25.25
220 KB Posted
- Attached to
- DEP-NERO-RFQ-PRF77A-Asbestos Sample Analysis
- Solicitation number
- BD-27-1045-NERO0-NERO1-132712
- Issued by
- Massachusetts
About this file
This is a Contractor Authorized Signatory Listing (CASL) form jointly issued by the Commonwealth of Massachusetts Office of the Comptroller and the Operational Services Division for use by all state departments when another form is not prescribed by regulation or policy. The form is designed to establish authorized signatories for contractors, sole proprietors, and individuals who execute contracts and legally binding documents on behalf of a contractor. The document requires a notarized signature from the authorized person, which must be completed in the presence of a notary public and match the contractor's Form W-9 tax classification.
The form collects essential contractor identification information including the contractor's legal name and vendor/customer code. Signatories must provide ink-on-paper signatures and include their full legal name and title. A notary public must certify the signatory's identity and acknowledgment of the signature's purpose, provide their name and signature in ink, note their commission expiration date, and affix their official seal or stamp to the document. The completed form must be attached to the record copy of any contract filed with the applicable department. The Commonwealth reserves the right to publish the names and titles of authorized signatories, though contractors are instructed not to attach documentation containing sensitive personal information such as bank account numbers, social security numbers, or other personally identifiable information.
Text of this file
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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