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

DATE (MM/DD/YYYY) EVIDENCE OF PROPERTY INSURANCE 08/25/2025 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY PHONE COMPANY (A/C, No, Ext): Phillips Stafford Insurance Group 809 8th St SW Columbia National Insurance Suite D P O Box 618 Altoona IA 50009 FAX E-MAIL [email protected] Columbia MO 65205 (A/C, No): ADDRESS: CODE: 18780 SUB CODE: 18780 AGENCY 00005714 CUSTOMER ID #: INSURED LOAN NUMBER POLICY NUMBER Phillips Floors Inc CMPIA2000025839 1605 N 9th St EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL 07/01/2025 07/01/2026 TERMINATED IF CHECKED Indianola IA 50125-4835 THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATION/DESCRIPTION 1605 N 9th St Indianola IA 50125-4835 Loc# 00001/Bldg# 00001 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE INFORMATION PERILS INSURED BASIC BROAD SPECIAL COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE Personal Property, Replacement Cost, Special form 267,869 2,500 REMARKS (Including Special Conditions) Project: 250120; City of Tiffin Community Recreation Center; 105 S Park Road, Tiffin, IA 52340 Location Stored: 1605 N 9th St, Indianola, IA 50125 Materials Stored: RAF, AF, and Turf Materials Value: 117,482.00 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NAME AND ADDRESS ADDITIONAL INSURED LENDER'S LOSS PAYABLE LOSS PAYEE MORTGAGEE Additional interest LOAN # City of Tiffin & Miron Construction Co., Inc. 335 French CT. AUTHORIZED REPRESENTATIVE Cedar Rapids IA 52404 ACORD 27 (2016/03) © 1993-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD