K-4 - Pay Estimate 1 - Boomerang Construction - North Park Road

APPLICATION FOR PARTIAL PAYMENT OF CONTRACT Project Title: STP-U-7662(615)--70-52 N. Park Road PCC Pavement Widening w/ PCC Resurfacing Contractor: Boomerang Corp. Address: 13225 Circle Dr Suite A, Anamosa, IA 52205 Finance Budget Code: Finance Project # Vendor Project or Invoice #: PO # Original Contract Date: December 17, 2024 Vendor # Date of Council Meeting: April 1, 2025 PAYMENT REQUEST # 1 PAYMENT PERIOD: From: March 3, 2025 Through: March 16, 2025 Contract Summary Original Contract Amount: $ 5,458,891.91 Net change by Change Orders: $ - Contract Amount to Date: (line 1 ± 2) $ 5,458,891.91 Total completed and stored to date: $ 178,258.80 Retainage: 3 % of Completed Work: $ 5,347.76 Total Earned less Retainage: $ 172,911.04 Less previous applications for payment: $ - SUBTOTAL $ 172,911.04 OTHER CHARGES (Attach an itemized list) $ - CURRENT PAYMENT DUE $ 172,911.04 Balance to finish, including retainage: $ 5,285,980.87 Notice to Proceed: January 30, 2025 Contract Time Remaining (If applicable) 200 days 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 the amounts have been paid by the Contractor for work for which previous Certificate(s) for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. Construction Contractor Approval: Boomerang Corp. Dakota Simonsen Signature Firm Name Date 03/24/2025 Engineer / Consultant Approval: MSA Professional Services, Inc. Firm Name 03/24/2025 Signature Date Owner Approval: City of Tiffin Firm Name Signature Date Submit to: Kelda Hankins E-mail: [email protected] Phone: 319-536-3493 Fax: Date Printed: 3/24/2025