Discussion and Consideration of Pay Application #9 – Miron Construction – Tiffin Recreation Center – Motion to Approve — K-3

RECEIPT AND WAIVER OF MECHANIC’S LIEN RIGHTS Date: __12/11/2025_________________ The undersigned hereby acknowledged receipt of the sum of $__3750.00____________________ CHECK ONLY ONE 1) _X___As partial payment of labor, skill and material furnished. 2) ____As payment for all labor, skill and material furnished or to be furnished (except the sum of $_________________retainage or hold back). 3) ____As full and final payment for all labor, skill and material furnished or to be furnished to the following described real property: (legal description, street address or project name) City of Tiffin Community Recreation Center 105 S. Park Rd Tiffin, IA 52340 and of value received hereby waives all rights acquired by the undersigned to file or record mechanic’s lien against said real property for labor, skill or material furnished to said real property (only for the amount paid if line 1 is checked, and except for retainage shown if line 2 is checked). The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Customer: Ilten’s, Inc. Vendor: Chestnut Designs & Consulting 919 14th Ave SW Cedar Rapids, IA 52404 ________________________________Signature ____Corey Chestnut________________Name ____President_____________________Title ____1051 20th Street SE_____________Address ____Cedar Rapids, IA 52403_________City, State Zip