staff report memo · E-8
Approval of State Revolving Fund (SRF) Reimbursement Request #9 - Water Treatment Facility Upgrade Project — E-8
Page 3 of 14
Text read by the vision model; check the PDF for anything that matters.Contractor's Application for Payment
<table>
<tr>
<th>Owner:</th>
<td>City of Tiffin</td>
<th>Owner's Project No.:</th>
<td></td>
</tr>
<tr>
<th>Engineer:</th>
<td>MSA Professional Services</td>
<th>Engineer's Project No.:</th>
<td>13603016</td>
</tr>
<tr>
<th>Contractor:</th>
<td>Tricon Construction Group</td>
<th>Contractor's Project No.:</th>
<td></td>
</tr>
<tr>
<th>Project:</th>
<td>Water Treatment Plant Upgrades - City of Tiffin</td>
<th colspan="2"></th>
</tr>
<tr>
<th>Contract:</th>
<td>Water Treatment Plant Upgrades</td>
<th colspan="2"></th>
</tr>
</table>
Application No.: 13 Application Date: 9/25/2026
Application Period: From 8/22/2026 to 9/24/2026
<table>
<tr>
<th>1. Original Contract Price</th>
<td>$12,182,553.00</td>
</tr>
<tr>
<th>2. Net change by Change Orders</th>
<td>$20,148.91</td>
</tr>
<tr>
<th>3. Current Contract Price (Line 1 + Line 2)</th>
<td>$12,202,701.91</td>
</tr>
<tr>
<th>4. Total Work completed and materials stored to date<br>(Sum of Column G Lump Sum Total and Column G Unit Price Total)</th>
<td>$10,210,068.95</td>
</tr>
<tr>
<th>5. Retainage<br>a. 5% X $9,857,692.34 Work Completed</th>
<td>$492,884.62</td>
</tr>
<tr>
<th>b. 5% X $352,376.61 Stored Materials</th>
<td>$17,618.83</td>
</tr>
<tr>
<th>c. Total Retainage (Line 5.a + Line 5.b)</th>
<td>$510,503.45</td>
</tr>
<tr>
<th>6. Amount eligible to date (Line 4 - Line 5.c)</th>
<td>$9,699,565.50</td>
</tr>
<tr>
<th>7. Less previous payments (Line 6 from prior application)</th>
<td>$8,886,480.76</td>
</tr>
<tr>
<th>8. Amount due this application</th>
<td>$813,084.72</td>
</tr>
<tr>
<th>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</th>
<td>$2,503,136.41</td>
</tr>
</table>
Contractor's Certification
The undersigned Contractor certifies, to the best of its knowledge, the following:
Contractor: Tricon Construction Group
Signature: [signature]
Date: 9/25/26
PAYMENT OF: $813,084.72
(line 8 or other - attach explanation of the other amount)
Recommended by Engineer
By: [signature]
Title: Senior Project Engineer
Date: 10/1/26
Approved by Funding Agency
By: [signature]
Title: [title]
Approved by Owner
By: [signature]
Title: [title]
Date: [date] Date: [date]
Sources
- revize: E-8 (CXXk4xGHfLkQEVVmiQumPVj5NLdFHf.pdf) — where it was found ↗ first seen Oct 12, 2026
Attached to agenda item: E-8 Approval of State Revolving Fund (SRF) Reimbursement Request #9 - Water Treatment...
Data last updated October 15, 2026. Built from the archive's documents; see how the data is built.