Packet: Tiffin Regular City Council Meeting (02/17/2026)

PAYMENT APPLICATION DATE: 1-19-26 PROJECT NAME: City of Tiffin Community Recreation Center ADDRESS: Tiffin, IA CONTRACT FOR: FI-09.66 32.18/Resilient Athletic Flooring Turf Surfacing MIRON PROJECT: 250120 REQUEST NUMBER: 1 INVOICE NUMBER: 1 CONTRACT #: 250120-000026 VENDOR#: 00017926 PERIOD FROM: 1/1/26 TO: 1/30/26 INVOICE DATE: 1/19/26 <table> <tr> <th>ORIGINAL CONTRACT AMOUNT</th> <td>$266,500.00</td> </tr> <tr> <th>APPROVED CHANGE ORDERS AS OF August 21, 2025</th> <td>$0.00</td> </tr> <tr> <th>ADJUSTED CONTRACT AMOUNT</th> <td>$266,500.00</td> </tr> <tr> <th>TOTAL COMPLETED TO DATE</th> <td>$818.00</td> </tr> <tr> <th>PREVIOUS REQUESTS FOR PAYMENT</th> <td>$0.00</td> </tr> <tr> <th>TOTAL EARNED THIS REQUEST</th> <td>$818.00</td> </tr> <tr> <th>LESS 5% RETAINAGE</th> <td>$40.90</td> </tr> <tr> <th>CURRENT PAYMENT DUE</th> <td>$777.10</td> </tr> </table> VENDOR: Phillips Floors Inc SIGNED: [signature] TITLE: Vice President *** REQUESTS WILL NOT BE PROCESSED UNTIL THEY ARE SUBMITTED TO MIRON VIA E-MAIL IN A PDF FORMAT TO [email protected] OR ORIGINALS ARE RECEIVED. FAX 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.