staff report memo · K-2
Discussion and Consideration of Approval of State Revolving Fund (SRF) Reimbursement Request #1 – Water Treatment Facility Upgrade Project – Motion to Approve
Page 44 of 66
Text read by the vision model; check the PDF for anything that matters.Contractor's Application for Payment
Owner: City of Tiffin
Engineer: MSA Professional Services
Contractor: Tricon Construction Group
Project: Water Treatment Plant Upgrades - City of Tiffin
Contract: Water Treatment Plant Upgrades
Owner's Project No.: ____________________________
Engineer's Project No.: 13603016
Contractor's Project No.: _________________________
Application No.: 4
Application Date: 11/21/2025
Application Period: From 10/24/2025 to 11/30/2025
<table>
<tr>
<th> </th>
<th> </th>
<th> </th>
</tr>
<tr>
<td>1. Original Contract Price</td>
<td>$</td>
<td>12,182,553.00</td>
</tr>
<tr>
<td>2. Net change by Change Orders</td>
<td>$</td>
<td>12,420.34</td>
</tr>
<tr>
<td>3. Current Contract Price (Line 1 + Line 2)</td>
<td>$</td>
<td>12,194,973.34</td>
</tr>
<tr>
<td>4. Total Work completed and materials stored to date<br>(Sum of Column G Lump Sum Total and Column G Unit Price Total)</td>
<td>$</td>
<td>1,759,214.72</td>
</tr>
<tr>
<td>5. Retainage<br>a. 5% X $ 1,738,164.72 Work Completed<br>b. 5% X $ 21,050.00 Stored Materials<br>c. Total Retainage (Line 5.a + Line 5.b)</td>
<td>$</td>
<td>86,908.24<br>1,052.50<br>87,960.74</td>
</tr>
<tr>
<td>6. Amount eligible to date (Line 4 - Line 5.c)</td>
<td>$</td>
<td>1,671,253.98</td>
</tr>
<tr>
<td>7. Less previous payments (Line 6 from prior application)</td>
<td>$</td>
<td>1,168,804.48</td>
</tr>
<tr>
<td>8. Amount due this application</td>
<td>$</td>
<td>502,449.50</td>
</tr>
<tr>
<td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td>
<td>$</td>
<td>10,523,719.36</td>
</tr>
</table>
Contractor's Certification
The undersigned Contractor certifies, to the best of its knowledge, the following:
Contractor: Tricon Construction Group
Signature: Mary K Stone
Date: 11/25/2025
PAYMENT OF: $502,449.50
(line 8 or other - attach explanation of the other amount)
Recommended by Engineer
By: [signature]
Title: Senior Project Engineer
Date: 11/26/25
Approved by Funding Agency
By: __________________________
Title: ________________________
Approved by Owner
By: __________________________
Title: ________________________
Date: __________________________ Date: __________________________
Sources
- revize: Attachment (26JocivB3GX4YblLGOV44P4O7G93q8.pdf) — where it was found ↗ first seen Oct 12, 2026
Attached to agenda item: K-2 Discussion and Consideration of Approval of State Revolving Fund (SRF) Reimbursement...
Data last updated October 18, 2026. Built from the archive's documents; see how the data is built.