Shippers PAL Material Transmittal Form GS-13 Form 3

FAX to: 573-526-5636 or EMAIL to: PAL@modot.mo.gov

For assistance call: 573-751-6735
Shipper Name:
Contractor:
FAX Number: Phone Number:

The following material will be shipped to the indicated project. The material meets PAL requirements.
Material with Heat # or Lot # Brand Name Contract No. Line No. Shipping Quantity PAL Ident. No.
(and Manufacturer if different than Shipper) (may not apply) (Entered by MoDOT)
Date & Units

Name: _________________________________ Response Desired By: Required For All Steel Products
I hereby certify that the steel referenced above is in compliance with
Title: _________________________________ Email Fax Title 23, CFR, Buy America Requirements per MoDOT Specification
Sec 106.9.
Date: _________________________________
Signature: ____________________________________________
Email Address: ________________________________________________
A PAL Material Transmittal Form must precede every PAL material shipment.
All required material documentation must accompany this form.