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: ___1/16/2026________________ The undersigned hereby acknowledged receipt of the sum of $__750.00_____(seven hundred fifty & no/100) CHECK ONLY ONE 1) __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) _X___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 _______P.O. Box 1822______________Address _______Cedar Rapids, IA 52403_______City, State Zip