Approval of Pay Application #13 – Rathje Construction Co. – Original Town Urbanization – Phase 3 — E-4

TO (OWNER): City of Tiffin 300 Railroad St Tiffin, IA 52340 PROJECT: Original Town Urbaniz Ph3 241 W 3rd St IA 52340 APPLICATION NO: 13 PERIOD TO: 7/31/2026 DISTRIBUTION TO: - OWNER - ARCHITECT - CONTRACTOR FROM (CONTRACTOR): Rathje Construction Co. 305 44th St P.O. Box 408 Marion, IA 52302-0408 VIA (ARCHITECT): ARCHITECT'S PROJECT NO: CONTRACT FOR: 7476-24 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Type Document is attached. 1. ORIGINAL CONTRACT SUM ......................... $ 2,134,856.90 2. Net Change by Change Orders .................... $ 199,447.12 3. CONTRACT SUM TO DATE (Line 1 + 2) ............. $ 2,334,304.02 4. TOTAL COMPLETED AND STORED TO DATE .......... $ 2,420,991.85 5. RETAINAGE: a. 6.00 % of Completed Work $ 121,049.64 b. 0.00 % of Stored Material $ 0.00 Total retainage (Line 5a + 5b) .................. $ 121,049.64 6. TOTAL EARNED LESS RETAINAGE ................... $ 2,299,942.21 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) .................... $ 2,189,167.98 8. CURRENT PAYMENT DUE ............................. $ 110,774.23 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 8) ................................ $ 34,361.81 <table> <tr> <th>CHANGE ORDER SUMMARY</th> <th>ADDITIONS</th> <th>DEDUCTIONS</th> </tr> <tr> <td>Total changes approved in previous months by Owner</td> <td>182,857.12</td> <td>0.00</td> </tr> <tr> <td>Total approved this Month</td> <td>16,590.00</td> <td>0.00</td> </tr> <tr> <td>TOTALS</td> <td>199,447.12</td> <td>0.00</td> </tr> <tr> <td>NET CHANGES by Change Order</td> <td>199,447.12</td> <td></td> </tr> </table> CONTRACT DATE: The Undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the work covered by this application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the owner, and that current payment shown herein is now due. CONTRACTOR: Rathje Construction Co. 305 44th St P.O. Box 408 Marion, IA 52302-0408 By: [signature] Date: 8-6-2024 State of: County of: Subscribed and Sworn to before me this Day of 20 ___ Notary Public: My Commission Expires: ARCHITECT'S CERTIFICATE FOR PAYMENT In Accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the Architect certifies to owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED: $_____________________ (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: By: ____________________________ Date: ________________ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, Payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.