Packet: Tiffin Regular City Council Meeting (04/21/2026)

Docusign Envelope iD: 96E7B36D-88E7-4453-A484-088333187D1B Building Excellence PAYMENT APPLICATION DATE: LiLo PROJECT NAME: City of Tiffin Community Recreation Center ADDRESS: Tiffin, JA CONTRACT FOR: F108 40/Aluminum Windows, Entrances, Glass/Glazing MIRON PROJECT: 250120 CONTRACT #: 250120-000015 VENDOR#: 00003937 REQUEST NUMBER: — Z PERIOD FROM: /#h /, 2026 To: feb a 2% 2026 ? INVOICE NUMBER: _ ‘2/4022 INVOICE DATE: _ @//4/.L ORIGINAL CONTRACT AMOUNT $389,300.00 APPROVED CHANGE ORDERS AS OF August 18, 2025 ADJUSTED CONTRACT AMOUNT TOTAL COMPLETED TO DATE 182,815.00 PREVIOUS REQUESTS FOR PAYMENT FG|, 600,00 TOTAL EARNED THIS REQUEST VU ,SiS,6D LESS 5% RETAINAGE 4,590.95 CURRENT PAYMENT DUE $7224,25 VENDOR: Zephyr Aluminum Products SIGNED: TA Co ee TITLE: ite fresicterd- + REQUESTS WILL NOT BE PROCESSED UNTIL THEY ARE SUBMITTED TO MIRON VIA E-MAIL IN A PDF FORMAT TO [email protected] ORIGINALS ARE RECEIVED. FAK COPIES WILL NOT BE ACCEPTED. * EACH PAYMENT APPLICATION MUST INCLUDE AN UP TO DATE SCHEDULE OF VALUES, INCLUDING SUB TIER SUPPLIER/SUBCONTRACTOR BREAKDOWN AND CURRENT PAYMENT STATUS. CHANGE ORDERS ISSUED TO DATE MUST BE REFLECTED ON THE CURRENT SCHEDULE OF VALUES. 1474 McMahon Drive, Neenah, W! 54856-6305 » P.O, Box 508, Neenah, WI 54957-0509+ PH 920.969.7000 FAX 920.969.7000 MIRON-CONSTRUCTION.COM