DCR 971_Vendor Name_CASL SoleProprietors.pdf
PDF 220 KB Posted
- Solicitation number
- BD-26-1020-DCRCU-DC250-122530
- Issued by
- Suffolk County, Boston City, Massachusetts
About this file
Commonwealth of Massachusetts Contractor Authorized Signatory Listing (CASL) Form
This is a notarized signatory authorization form jointly issued by the Office of the Comptroller (CTR) and the Operational Services Division (OSD) of the Commonwealth of Massachusetts for use by all state departments when no other prescribed form exists. The form is required for any contractor, sole-proprietor, or individual to authorize a designated person to sign contracts and legally binding documents on the contractor's behalf. The document must include the contractor's legal name and vendor/customer code, the authorized signatory's full legal name and title, and an ink signature completed in the presence of a notary public. The form requires notarization with the notary public certifying that the signatory's identity was verified through satisfactory evidence and that the individual acknowledged signing the document for its stated purpose. The notary must provide their printed name, ink signature, commission expiration date, and affix their official seal or stamp to the form.
The completed form must be retained as part of the record copy of any executed contract filed with the respective Commonwealth department. Contractors are instructed not to attach any documentation containing personal information, including bank account numbers, social security numbers, driver's licenses, home addresses, or other personally identifiable information, as the Commonwealth reserves the right to publish the names and titles of authorized signatories as part of the public record. This form serves as the standard authorization document across all Commonwealth contracting activities unless department-specific regulations or policies dictate otherwise.
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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 .