Packet: Tiffin Regular City Council Meeting (10/06/2026)

Contractor's Application for Payment Owner: City of Tiffin Engineer: MSA Professional Services Contractor: Neumiller Electric, Inc Project: Roberts Ferry Rd & Village Dr Traffic Signal Improvements Contract: Traffic Signal Improvements Owner's Project No.: ______________________ Engineer's Project No.: 13603030 Contractor's Project No.: 26-084-U Application No.: 1 Application Date: 9/25/2026 Application Period: From 6/2/2026 to 9/20/2026 <table> <tr> <th> </th> <th> </th> <th> </th> </tr> <tr> <td>1. Original Contract Price</td> <td></td> <td>$367,853.75</td> </tr> <tr> <td>2. Net change by Change Orders</td> <td></td> <td>$-</td> </tr> <tr> <td>3. Current Contract Price (Line 1 + Line 2)</td> <td></td> <td>$367,853.75</td> </tr> <tr> <td>4. Total Work completed and materials stored to date<br>(Sum of Column G Lump Sum Total and Column G Unit Price Total)</td> <td></td> <td>$209,767.29</td> </tr> <tr> <td>5. Retainage<br>a. 3% X $112,387.29 Work Completed</td> <td></td> <td>$3,371.62</td> </tr> <tr> <td>b. 3% X $97,380.00 Stored Materials</td> <td></td> <td>$2,921.40</td> </tr> <tr> <td>c. Total Retainage (Line 5.a + Line 5.b)</td> <td></td> <td>$6,293.02</td> </tr> <tr> <td>6. Amount eligible to date (Line 4 - Line 5.c)</td> <td></td> <td>$203,474.27</td> </tr> <tr> <td>7. Less previous payments (Line 6 from prior application)</td> <td></td> <td>$-</td> </tr> <tr> <td>8. Amount due this application</td> <td></td> <td>$203,474.27</td> </tr> <tr> <td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td> <td></td> <td>$164,379.48</td> </tr> </table> Contractor's Certification The undersigned Contractor certifies, to the best of its knowledge, the following: Contractor: Neumiller Electric, Inc. Signature: [signature] Date: 9-28-2026 PAYMENT OF: $203,474.27 (line 8 or other - attach explanation of the other amount) Recommended by Engineer By: ____________________________ Title: Project Manager Date: 09/29/2026 Approved by Owner By: ____________________________ Title: __________________________ Date: _________________________ Approved by Funding Agency By: ____________________________ Title: __________________________ Date: _________________________