Packet: Tiffin City Council Regular Meeting (03/03/2026)

Contractor's Application for Payment <table> <tr> <th>Owner:</th> <td>City of Tiffin</td> <th>Owner's Project No.:</th> <td></td> </tr> <tr> <th>Engineer:</th> <td>MSA Professional Services</td> <th>Engineer's Project No.:</th> <td>13603016</td> </tr> <tr> <th>Contractor:</th> <td>Tricon Construction Group</td> <th>Contractor's Project No.:</th> <td></td> </tr> <tr> <th>Project:</th> <td colspan="3">Water Treatment Plant Upgrades - City of Tiffin</td> </tr> <tr> <th>Contract:</th> <td colspan="3">Water Treatment Plant Upgrades</td> </tr> </table> Application No.: 6R Application Date: 2/20/2026 Application Period: From 1/24/2026 to 2/20/2026 <table> <tr> <th></th> <th></th> <th></th> <th></th> </tr> <tr> <td>1. Original Contract Price</td> <td>$</td> <td>12,182,553.00</td> <td></td> </tr> <tr> <td>2. Net change by Change Orders</td> <td>$</td> <td>12,420.34</td> <td></td> </tr> <tr> <td>3. Current Contract Price (Line 1 + Line 2)</td> <td>$</td> <td>12,194,973.34</td> <td></td> </tr> <tr> <td>4. Total Work completed and materials stored to date<br>(Sum of Column G Lump Sum Total and Column G Unit Price Total)</td> <td>$</td> <td>2,506,154.41</td> <td></td> </tr> <tr> <td>5. Retainage<br>a. 5% X $ 2,333,704.91 Work Completed<br>b. 5% X $ 172,449.50 Stored Materials<br>c. Total Retainage (Line 5.a + Line 5.b)</td> <td>$</td> <td>116,685.25<br>8,622.48<br>125,307.73</td> <td></td> </tr> <tr> <td>6. Amount eligible to date (Line 4 - Line 5.c)</td> <td>$</td> <td>2,380,846.68</td> <td></td> </tr> <tr> <td>7. Less previous payments (Line 6 from prior application)</td> <td>$</td> <td>1,823,406.04</td> <td></td> </tr> <tr> <td>8. <b>Amount due this application</b></td> <td>$</td> <td>557,440.64</td> <td></td> </tr> <tr> <td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td> <td>$</td> <td>9,814,126.66</td> <td></td> </tr> </table> Contractor's Certification The undersigned Contractor certifies, to the best of its knowledge, the following: <table> <tr> <th>Contractor:</th> <td>Tricon Construction Group</td> <th>Date:</th> <td>2/25/2026</td> </tr> <tr> <th>Signature:</th> <td>Mary K. Stone</td> <th></th> <td></td> </tr> </table> PAYMENT OF: $557,440.64 (line 8 or other - attach explanation of the other amount) Recommended by Engineer By: Clint Ware Title: Senior Project Engineer Date: 2/25/2026 Approved by Owner By: Title: Date: Approved by Funding Agency By: Title: By: Title: Date: ____________________________ Date: ____________________________