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

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></th> <th></th> <th></th> </tr> <tr> <td>1. Original Contract Price</td> <td>$12,182,553.00</td> <td></td> </tr> <tr> <td>2. Net change by Change Orders</td> <td>$20,148.91</td> <td></td> </tr> <tr> <td>3. Current Contract Price (Line 1 + Line 2)</td> <td>$12,202,701.91</td> <td></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>$10,210,068.95</td> <td></td> </tr> <tr> <td>5. Retainage<br>a. 5% X $9,857,692.34 Work Completed<br>b. 5% X $352,376.61 Stored Materials<br>c. Total Retainage (Line 5.a + Line 5.b)</td> <td>$492,884.62<br>$17,618.83<br>$510,503.45</td> <td></td> </tr> <tr> <td>6. Amount eligible to date (Line 4 - Line 5.c)</td> <td>$9,699,565.50</td> <td></td> </tr> <tr> <td>7. Less previous payments (Line 6 from prior application)</td> <td>$8,886,480.76</td> <td></td> </tr> <tr> <td>8. Amount due this application</td> <td>$813,084.72</td> <td></td> </tr> <tr> <td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td> <td>$2,503,136.41</td> <td></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: ____________________________