form_contractor-authorized-signatory-listing-for-sole-proprietors.pdf
PDF 220 KB Posted
- Attached to
- Entertainer RFR
- Solicitation number
- BD-26-1053-1053C-CSR-126558
- 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. The form is designed for use by all Commonwealth departments when another form is not prescribed by regulation or policy. The document requires sole proprietors, individuals, and single-member LLCs to provide a notarized signature from an authorized person who can execute contracts and legally binding documents on behalf of the contractor. The signatory must complete the form in the presence of a notary public, providing their legal name, title, and the contractor's legal name and vendor/customer code. The form includes a certificate of acknowledgement section where the notary public certifies that the signatory proved their identity through satisfactory identification and acknowledged signing the document for its stated purpose. A copy of the completed form must be attached to the record copy of the contract filed with the relevant department.
The form emphasizes privacy protection by instructing contractors not to attach documentation containing personally identifiable information such as bank account numbers, social security numbers, driver's licenses, or home addresses. The Commonwealth reserves the right to publish the names and titles of authorized signatories as part of the public record. The form requires original ink signatures from both the contractor's signatory and the notary public, along with the notary's seal or stamp and commission expiration date. This form applies to the Entertainer RFR opportunity at the Massachusetts Veterans Home at Holyoke, which seeks experienced entertainment providers for onsite performances for resident veterans.
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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 .