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

Customer: PHILLIPS' FLOORS INC. 1605 N 9TH ST INDIANOLA, WARREN IA 50125 USA Shipping address: PHILLIPS' FLOORS INC. 1605 N 9TH ST INDIANOLA, WARREN IA 50125 Beth (515) 961-7300 Telephone: (515) 961-7300 <table> <tr> <th>Customer purchase order no</th> <th>Ship Via</th> <th>P.O.B.</th> <th>Terms</th> </tr> <tr> <td>PF-202051-5</td> <td>TQL LOGISTICS</td> <td></td> <td>NET 30</td> </tr> </table> <table> <tr> <th>Item Number</th> <th>Unit</th> <th>Order Quantity</th> <th>Ship Quantity</th> <th>Backorder Quantity</th> <th>Unit price</th> <th>Price UOM</th> <th>Gross amount</th> </tr> <tr> <td>WELDING ROD 5 MM GREY</td> <td>Wheel</td> <td>01</td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>Serials:</td> <td>CTL_WR0204</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>Serial numbers:</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>1538708TARK</td> <td>KIT</td> <td>113.000</td> <td>113.000</td> <td>0.000</td> <td>169.000</td> <td>KIT</td> <td>19097.00</td> </tr> <tr> <td></td> <td></td> <td>113.00</td> <td>113.00</td> <td>0.00</td> <td>169.00</td> <td></td> <td></td> </tr> <tr> <td>TARKETT MULTI-POXY ADHESIVE 2GAL PAIL</td> <td>Wheel</td> <td>01</td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>Serials:</td> <td>95204<br>95205<br>95206</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>Serial numbers:</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>HPL 5 mm with scrim</td> <td>SQF</td> <td>7671.250</td> <td>7671.250</td> <td>0.000</td> <td>2.340</td> <td>SQF</td> <td>17950.73</td> </tr> <tr> <td>HPL 5 mm with scrim</td> <td>Wheel</td> <td>01</td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>Serials:</td> <td>96115<br>96116<br>96117<br>96118<br>96119</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>Serial numbers:</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>3917009</td> <td>SQF</td> <td>7833.280</td> <td>7833.280</td> <td>0.000</td> <td>2.330</td> <td>SQF</td> <td>18251.54</td> </tr> </table>