K-2 - Pay Application 3 Final - McComas Lacina - Sidewalk to Soccer Fields

APPLICATION FOR PARTIAL PAYMENT OF CONTRACT Project Title: Tiffin Sidewalk Connection to Soccer Fields Contractor: McComas-Lacina Construction LC Address: 1310 Highland Court, Iowa City, IA 52240 Finance Budget Code: Finance Project # ________ Vendor Project or Invoice #: 34431-03 FINAL PO # ________ Original Contract Date: December 7, 2023 Engineer PN # 13603015 Date of Council Meeting: June 4, 2024 PAYMENT REQUEST # 3/FINAL PAYMENT PERIOD: From: May 1, 2024 Through: May 31, 2024 Contract Summary Original Contract Amount: $ 64,935.54 Net change by Change Orders: $ - Contract Amount to Date: (line 1 ± 2) $ 64,935.54 Total completed and stored to date: $ 64,935.54 Retainage: 0 % of Completed Work: $ - Total Earned less Retainage: $ 64,935.54 Less previous applications for payment: $ 58,082.37 SUBTOTAL $ 6,853.17 OTHER CHARGES (Attach an itemized list) $ - CURRENT PAYMENT DUE $ 6,853.17 Balance to finish, including retainage: $ - Notice to Proceed: December 14, 2023 Substantial Completion Date: May 24, 2024 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: McComas-Lacina Construction LC Firm Name Signature Date 5-24-24 Engineer / Consultant Approval: MSA Professional Services, Inc. Firm Name Signature Date 05/30/2024 Owner Approval: City of Tiffin Owner Name Signature Date