Contractor Authorized Signatory Listing Form CASL for Sole Proprietors~8.pdf
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- Solicitation number
- BD-26-1039-EHS01-ASHWA-129810
- 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 by all state departments unless otherwise prescribed by regulation or policy. The form is designed to document authorized signatories for contractors, sole proprietors, and individuals who are permitted to execute contracts and other legally binding documents on behalf of their organizations with the Commonwealth. The document requires a notarized signature of the authorized signatory, the contractor's legal name, vendor or customer code if available, the signatory's printed name and title, and a notary public's certification of the signatory's identity and acknowledgment. The form emphasizes that a copy must be attached to the record copy of any contract filed with the relevant department.
The form includes specific instructions prohibiting the attachment of documentation containing personally identifiable information such as bank account numbers, social security numbers, driver's licenses, home addresses, or social security cards, as the Commonwealth reserves the right to publish the names and titles of authorized signatories as part of the public record. All signatures must be executed in ink on paper in the presence of a notary public, and the notary must affix their seal or stamp to the completed form along with the expiration date of their commission.
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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: |
File details come from the government source that posted it. Updated .