Discussion and Consideration of Pay Application #10 – Miron Construction – Tiffin Recreation Center Project – Motion to Approve — K.2

ADDITIONAL REMARKS SCHEDULE AGENCY: TRICOR, LLC - Dubuque POLICY NUMBER: SEE PAGE 1 CARRIER: SEE PAGE 1 NAMED INSURED: Zephyr Aluminum Products 355 Huff Dubuque, IA 52003 NAIC CODE: SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: written contract or agreement. Umbrella is follow form. A 30 day notice of cancel applies. Wavier of Governmental Immunities applies in favor of City of Tiffin. Stored Materials at 555 Huff St., Dubuque, IA: $95,000