contract agreement · K-2
Discussion and Consideration of Pay Application #10 – Miron Construction – Tiffin Recreation Center Project – Motion to Approve — K.2
Page 8 of 17
Text read by the vision model; check the PDF for anything that matters.SWORN STATEMENT TO OWNER AND MIRON CONSTRUCTION CO., INC.
State of IA
County of Dubuque
Bruce Timmerman (Name) being first duly sworn, under oath says that he/she is VP (Title) of Zephyr Aluminum Products that has a PSA dated February 19, 2026 with Miron Construction Co., Inc. for Glazing (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 Zephyr Aluminum Products to furnish labor and/or materials on the Project. That there is due and to become due Zephyr Aluminum Products 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 Zephyr Aluminum Products and each Subcontractor and/or Supply Agent listed.
Signed: [Signature]
Subscribed and sworn to before me this 19th day of February 2026.
Signed: Theresa M May Notary Public
Theresa M May (Print Name)
My Commission expires: 5/16/24
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.
Sources
- revize: K.2 (8ML5xkHm6nq6U17AdBvw3UCIhe3sAu.pdf) — where it was found ↗ first seen Oct 12, 2026
Attached to agenda item: K-2 Discussion and Consideration of Pay Application #10 – Miron Construction – Tiffin...
Data last updated October 15, 2026. Built from the archive's documents; see how the data is built.