MATERIAL SUBMITTAL Client / Contractor Logo

To : NEW SUBMITTAL RESUBMITTAL

From : Submittal No. : Revision :
Project Name : Date :
Project No. : Ref. Specs. Sec. No. :
Customer :

For the Contractor Use For the Consultant / Customer Use

Reference Document
Description of Item Submitted (Type, Size, Model Manufacturer / Contractor/ No. of Review
SN
No., etc.) Drawing / Brochure No. Copies Remarks
Specs. Para. Drawing Variation Code
No. Sheet. No. (Y/N)

Remarks: Code:
(1) Approved (3) Rejected (5) Addt'l. Information Required
(2) Approved as Noted (4) Revise & Resubmit (6) Material Submittal Required

For the contents of this submittal, approval by the Consultant and/or the Engineer shall not relieve the
The Contractor certifies that all above submitted items have been reviewed in detail and are correct
Contractor of his obligation under the Contract, and the Contractor shall be solely responsible for the
in strict conformance with the Contract drawings and specifications except otherwise stated.
soundness and correctness of the submitted documents.

Contractor Contractor Stamp Consultant Approving Authority

Name : Name :
Title : Title :
Signature : Signature :
WI-PST-12-01 633195461.xls
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Date : Date :

WI-PST-12-01 633195461.xls
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