READ CASL_Sole Proprietor.pdf
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- Attached to
- DMH Training Master Agreement RFA
- Solicitation number
- BD-27-1022-DMH08-8210C-134629
- Issued by
- Massachusetts
About this file
This document is the Contractor Authorized Signatory Listing (CASL) Form, a standard form jointly issued by the Commonwealth of Massachusetts Office of the Comptroller and the Operational Services Division for use by all state departments. The form is designed for sole proprietors, individuals, and single-member LLCs to provide notarized authorization of individuals who are authorized to sign contracts and legally binding documents on behalf of the contractor. The form requires the contractor's legal name, vendor/customer code if available, the authorized signatory's full legal name and title, and an ink signature from the authorized representative. A notary public must witness the signatory's identification and signature, certify the acknowledgment, provide their name and signature in ink, and affix their official seal or stamp to the document.
The Commonwealth reserves the right to publish the names and titles of authorized signatories. The instructions explicitly prohibit attachment of documentation containing personally identifiable information such as bank account numbers, social security numbers, driver's licenses, home addresses, or social security cards to avoid public record disclosure. A copy of the completed CASL form must be attached to the record copy of any contract filed with the appropriate state department. This form is required as a prerequisite for contractors seeking to enter into agreements with Massachusetts state agencies, including those responding to the Department of Mental Health's Training Services Master Agreement Request for Applications.
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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 .