Approval of Pay Application #15 – Miron Construction – Community Recreation Center — E-4

APPLICATION AND CERTIFICATE FOR PAYMENT TO OWNER: City of Tiffin 300 Railroad St Tiffin, IA 52340 USA FROM Miron Construction Co., Inc. CONTRACTOR: PO Box 1372 Green Bay, WI 54305-1372 PROJECT: City of Tiffin Community Recreation Center 105 S Park Road Tiffin, IA 52340 USA ARCHITECT: Atura Architecture 912 North 13th Street Clear Lake, IA 50428 APPLICATION NO.: 15 PERIOD TO: 07/31/2026 PROJECT NOS.: 250120 INVOICE NO.: 250120-0015 CONTRACT DATE: 11/19/2024 CONTRACT FOR: City of Tiffin Community Recreation Center APPLICATION AND CERTIFICATE FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation sheet is attached. 1. ORIGINAL CONTRACT SUM ................. $ 12,435,142.00 2. Net change by change orders ............... $ -1,042,001.88 3. CONTRACT SUM TO DATE (Line1 +/- 2) ...... $ 11,393,140.12 4. TOTAL COMPLETED & STORED TO DATE ....... $ 8,990,740.96 (Column G on G703) 5. RETAINAGE: (Total retainage Column I of G703) ............ $ 449,537.06 6. TOTAL EARNED LESS RETAINAGE .......... $ 8,541,203.90 (Line 4 less Line 5 Total ) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) ................ $ 7,802,095.53 8. CURRENT PAYMENT DUE ..................... $ 739,108.37 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6 ) $ 2,851,936.22 <table> <tr> <th>CHANGE ORDER SUMMARY</th> <th>ADDITIONS</th> <th>DEDUCTIONS</th> </tr> <tr> <td>Change Order approved in previous months by Owner</td> <td>0.00</td> <td>-1,042,001.88</td> </tr> <tr> <th colspan="3">APPROVED THIS MONTH</th> </tr> <tr> <td>Number</td> <td>Date Approved</td> <td></td> </tr> <tr> <td colspan="2">Current Total:</td> <td>0.00</td> </tr> </table> Net Change by Change Orders $ -1,042,001.88 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 amounts have been paid by the Contractor for Work for which previous Certificates for payment were issued and payments received from the Owner, and that current payment shown herein is now due. WARNING: DO NOT CHANGE ESTABLISHED PAYMENT INSTRUCTIONS FOR PAYMENTS TO MIRON CONSTRUCTION CO., INC.. Miron Construction Co., Inc. does not change its bank routing or account numbers. Do not accept or rely upon emails or correspondence requesting changes to Miron Construction Co., Inc.'s established payment instructions. Any change to Miron Construction Co., Inc.'s payment instructions can only be made by a fully executed Change Order to the Agreement between Owner and Miron Construction Co., Inc.. Contractor: Miron Construction Co., Inc. By: [signature] Date: July 27, 2026 State of: Wisconsin County of: Winnebago Subscribed and sworn to before me this 27 day of July 2026 Notary Public: Michelle A Sommerfeld My Commission expires: 07.10.2030 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to the payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED............................$ 739,108.37 (Attach explanation If amount certified differs from the amount applied for. Initial figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) By: ____________________________ City of Tiffin ARCHITECT: Atura Architecture By: [signature] Date: 7/19/26 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.