Approval of State Revolving Fund (SRF) Planning and Design Reimbursement #1 – Water Treatment Plant — E-7

State Revolving Fund Planning and Design Loan Disbursement Request Borrower: Tiffin Contact: Doug Boldt, City Administrator Street Address: 300 Railroad Street; PO Box 259 Email: [email protected] City, State, Zip Tiffin, IA 52340 Phone: 319 545-2572 SRF Loan #: D0696P Closing Date 1/5/2024 Request Date: 9/15/2026 Final Request Maturity Date 1/5/2027 Request #: 1 Yes or No: Y Loan Amount: $ 143,774.00 Expenses Total Expenses Other Funding SRF Funding Legal and Muncipal Administrative Archaeological or Contribution from SRF Disbursement Advisor Expenses Expenses Engineering Environmental Other Other Total Expenses other Sources in $$ Request Request #1 $ 4,500.00 $ - $ 42,500.00 $ 74,737.74 $ 10,276.24 $ 132,013.98 $ 132,013.98 Request #2 $ - $ - Request #3 $ - $ - Request #4 $ - $ - Request #5 $ - $ - Request #6 $ - $ - Request #7 $ - $ - Request #8 $ - $ - Request #9 $ - $ - Request #10 $ - $ - Request #11 $ - $ - Request #12 $ - $ - Request #13 $ - $ - Request #14 $ - $ - Request #15 $ - $ - Request #16 $ - $ - Request #17 $ - $ - Request #18 $ - $ - Request #19 $ - $ - Request #20 $ - $ - Request #21 $ - $ - Request #22 $ - $ - Total $ 4,500.00 $ - $ 42,500.00 $ - $ 74,737.74 $ 10,276.24 $ 132,013.98 $ - $ 132,013.98 I hereby certify that this request for disbursement of SRF loan proceeds is a true and accurate request for disbursement; that it is made in accordance with the terms and $ 11,760.02 conditions of the above referenced SRF Loan Agreement; and that the corresponding invoices attached to the request and this request represents eligible project costs not P&D Available Balance previously requested. Typed or Printed Name and Title Signature of Authorized Representative