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

SWORN STATEMENT TO OWNER AND MIRON CONSTRUCTION CO., INC. State of Iowa County of Warren Matt Phillips (Name) being first duly sworn, under oath says that he/she is President (Title) of Phillips Floors Inc that has a PSA dated August 21, 2025, with Miron Construction Co., Inc. for Athletic Flooring and Turf (Work Type) on the City of Tiffin Community Recreation Center Project, and that: For the purposes of this Payment Application, certain Subcontractor and/or Supply Agents have contracted with Phillips Floors Inc to furnish labor and/or materials on the Project. That there is due and to become due Phillips Floors Inc and them, respectively, the amounts set forth opposite the names on the Payment Application Form for labor and/or materials as listed. That this statement and the attached Payment Application Form are full, true and complete statements of all such Subcontractor and/or Supply Agents, the amounts paid and the amounts due or to become due to Phillips Floors Inc and each Subcontractor and/or Supply Agent listed. Signed: Matt Phillips Subscribed and sworn to before me this 19th day of April, 2026. Signed: Mark A. Bjork Notary Public Mark A. Bjork (Print Name) My Commission expires: 3/11/2028 Notary Seal or Stamp: THIS NOTARIZED FORM MUST BE ATTACHED TO EACH PAYMENT APPLICATION FORM AND RETURNED WITH ALL APPLICABLE SIGNED AND NOTARIZED LIEN WAIVERS. FAILURE TO ABIDE BY THESE TERMS WILL RESULT IN DELAY OR REDUCTION IN REQUESTED PAYMENT.