K-3 - Pay Application 3 - Woodruff Construction - PW Building

TO: City of Tiffin DATE: May 4, 2022 PROJECT NO. I180.02 ATTENTION: Doug Boldt PROJECT: Tiffin Public Works Building RE: Pay Application #3 WE ARE SENDING YOU ☒ Attached ☐ Under separate cover via hand the following items: ☐ Contract ☐ Prints/Plans ☐ Samples ☐ Specifications ☒ Pay Request ☐ Copy of Letter ☐ Change Order ☐ <table> <tr> <th>Copies</th> <th>Date</th> <th>No.</th> <th>Description</th> </tr> <tr> <td>1</td> <td></td> <td>3</td> <td>Pay Application</td> </tr> <tr> <td>1</td> <td></td> <td></td> <td>Certificate of Insurance and photos of materials stored off-site</td> </tr> </table> THESE ARE TRANSMITTED as checked below: ☒ For approval ☐ No exceptions taken ☐ Resubmit copies for approval ☒ For your use ☐ Make corrections noted ☐ Submit copies for distribution ☐ As requested ☐ For review and comment ☐ Return corrected prints ☐ Rejected see remarks ☐ FOR BIDS DUE REMARKS: Retain one copy for your records. Print one copy and remit along with payment to Woodruff.