Contractor Authorized Signatory Form_ Sole Proprietors~2.pdf
PDF 220 KB Posted
- Attached to
- FWE-SURVEY-26 RFR
- Solicitation number
- BD-26-1046-COM-COM1-129270
- Issued by
- Massachusetts
About this file
This is a Contractor Authorized Signatory Listing (CASL) form issued jointly by the Commonwealth of Massachusetts Office of the Comptroller and the Operational Services Division for use across all state departments. The form applies to the FWE-SURVEY-26 RFR contract opportunity, under which the Massachusetts Department of Fish and Game, Department of Conservation and Recreation, Massachusetts Department of Agricultural Resources, and Division of Capital Asset Management and Maintenance seek qualified vendors to perform professional survey services and related services for department land acquisitions, exchanges, dispositions, and wetland and river restoration projects. The form serves as the standardized authorization document for all Commonwealth departments unless another form is prescribed by regulation or policy.
The CASL form requires a notarized signature from the authorized individual who is legally authorized to sign contracts and binding documents on behalf of the contractor. The form mandates that the signatory's signature appear in ink on paper and must be executed in the presence of a notary public. Contractors must provide their legal name, vendor or customer code if available, and the signatory's full legal name and title. The form explicitly prohibits attachment of documentation containing personally identifiable information such as bank account numbers, social security numbers, driver's licenses, or home addresses. A completed copy of this form must be attached to the record copy of any executed contract filed with the respective state department. The Commonwealth reserves the right to publish the names and titles of authorized signatories of contractors as 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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