Discussion and Consideration of Pay Application #12 – Miron Construction – Tiffin Recreation Center Project – Motion to Approve — K.2

Phillips Floors Inc Subcontractor/Supplier Contract List iron Project Name: City of Tiffin Community Recreation Center Miron Project #: 250120 Contract #: 250120-000026 Contract Amount: $266,500.00 <table> <tr> <th>Sub-tier Name</th> <th>PO#</th> <th>Material Description</th> <th>Address</th> <th>Phone #</th> <th>Original Sub-tier Contract / Estimate Amount</th> <th>Previous Payments</th> <th>Requested Payment for this month's billing</th> <th>Balance Remaining</th> <th>Lien Waiver Rec'd</th> </tr> <tr> <td>Hanks Specialty</td> <td>202051-3</td> <td>Floor Accessories</td> <td>2090 Old HWY 8 NW New Brighton MN</td> <td>651935020</td> <td>734.34</td> <td>734.34</td> <td>0</td> <td>0</td> <td>no</td> </tr> <tr> <td>FieldTurf</td> <td>202051-5&6</td> <td>AF-1-2-3, and Turf</td> <td>175 North Industrial Rd Calhoun GA</td> <td></td> <td>141,408.67</td> <td>0</td> <td>140,355.00</td> <td>1,053.67</td> <td>No</td> </tr> <tr> <td colspan="6">TOTAL:</td> <td>$743.00</td> <td>$140,355.00</td> <td>$1,053.67</td> <td></td> </tr> </table> Change Orders (at option of Miron's Project Manager) <table> <tr> <th></th> <th></th> <th></th> <th></th> <th></th> <th></th> <th></th> <th></th> <th></th> <th></th> </tr> <tr> <td colspan="6">TOTAL:</td> <td>$</td> <td>$</td> <td>$</td> <td>$</td> </tr> </table> Please email completed form to: [email protected] Please provide a detailed breakdown showing the amount to be paid to each sub-tier (subcontractor or supplier) on all pay requests. This information should so be identified on your Schedule of Values. In addition, we ask that you provide Lien Waivers from your sub-tiers. If for any reason lien waivers are not received and payment has not been met, Miron will hold future payments due to your company until it is confirmed that the previous pay requests have been paid out.