Msa Contractor Document Submittal Form

MSA CONTRACTOR DOCUMENT SUBMITTAL FORM (1) PROJECT (2) (3) SUBMITTAL REGISTER NO. (4) VERSION (5) DATE PREPARED NO. CONTRACT

(6) CONTRACTO (7) TO: PROJECT RECORDS SPECIALIST MSIN: Phone: 509- - R: RECEIVED BY E-mail: FAX: 509- - SIGNATURE DATE: PROJECT DATE: RECORDS (8) (9) (10) (11) (12) (13) (16) QTY/ DOCUMENT FORMAT TITLE / DESCRIPTION MSA REVIEW STATUS E NUMBER (DWG, MFC, P3, N GEN, B o. PDF) REV of - p B - NO C gs Y E S E

(17) SUBCONTRACTOR REMARKS (If this is a re-submittal to a previously approved submittal then explain why it is being re-submitted here.)

(18) REVIEWER DISTRIBUTION (HARD OR ELECTRONIC) NAME NAME NAME

(19) MSA (20) DUE (21) DUE DATE TO CONTRACTOR DOCUMENT DATE BACK APPROVER(S TO ) APPROVER(S )

(22) SUMMARY OF COMMENTS (IF ANY)

(23) BTR (25) (26) SUBMITTAL APPROVAL TYPE: (USED IN BLOCK 14) (27) SUBMITTAL REVIEW STATUS: CONCURREN SUBMITTAL (USED IN BLOCK 16) CE/APPROVA FORMAT: L: (NAME / (USED IN SIGNATURE / BLOCK 12) DATE)

of 2 A-6003-061 (REV 6) MSA CONTRACTOR DOCUMENT SUBMITTAL FORM (1) PROJECT (2) (3) SUBMITTAL REGISTER NO. (4) VERSION (5) DATE PREPARED NO. CONTRACT

/ / DWG = AutoCad APW = Approval Required A Conforms to the Contract Requirements GEN = Contractor’s Format Prior to Work (24) MFC = Microsoft Format Compatible AP = Approval Required B NO-No resubmit. Minor Comments. Approved PROJECT P3 = Primavera Schedule with exceptions as corrected. RECORDS PDF = Adobe Acrobat (Portable Document Format) SPECIALIST: HC = Hard Copy

[] Submittal Version Complete

[] Partial Complete PROJECT B YES-Resubmit. Minor Comments. Approved to proceed; however RECORDS resubmittal is required. SPECIALIST DATE: C Revise and Resubmit

of 2 A-6003-061 (REV 6)