Contractor Authorized Signatory Listing Form CASL for Sole Proprietors~7.pdf
PDF 220 KB Posted
- Solicitation number
- BD-26-1039-EHS01-ASHWA-128591
- Issued by
- Suffolk County, Boston City, Massachusetts
About this file
This is a Contractor Authorized Signatory Listing (CASL) Form jointly issued by the Commonwealth of Massachusetts Office of the Comptroller (CTR) and the Operational Services Division (OSD). The form serves as the default template for all Commonwealth departments when another form is not prescribed by regulation or policy. The document is designed to collect notarized signatures from authorized representatives of contractors, sole proprietors, or individuals who are legally authorized to sign contracts and other binding documents on behalf of the contracting entity. The form requires the contractor's legal name, vendor/customer code, and the authorized signatory's full legal name, title, and notarized signature affixed in the presence of a notary public.
The form includes specific instructions prohibiting the attachment of personally identifiable information such as bank account numbers, social security numbers, driver's licenses, or home addresses to maintain privacy and prevent unauthorized public record disclosure. Contractors must ensure that the notarized signature matches the tax classification listed on Form W-9. The Commonwealth reserves the right to publish the names and titles of authorized signatories. A completed copy of this form must be attached to the record copy of any contract filed with the respective Commonwealth department.
View the file
Other files
Show all 31
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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: |
File details come from the government source that posted it. Updated .