Packet: Tiffin Regular City Council Meeting (02/03/2026)

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.: 1 Application Date: 7/22/2025 Application Period: From 4/22/2025 to 7/30/2025 <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>482,234.02</td> <td></td> </tr> <tr> <td>5. Retainage<br>a. 5% X $ 482,234.02 Work Completed</td> <td>$</td> <td>24,111.70</td> <td></td> </tr> <tr> <td>b. 5% X $ - Stored Materials</td> <td>$</td> <td>-</td> <td></td> </tr> <tr> <td>c. Total Retainage (Line 5.a + Line 5.b)</td> <td>$</td> <td>24,111.70</td> <td></td> </tr> <tr> <td>6. Amount eligible to date (Line 4 - Line 5.c)</td> <td>$</td> <td>458,122.32</td> <td></td> </tr> <tr> <td>7. Less previous payments (Line 6 from prior application)</td> <td>$</td> <td>458,122.32</td> <td></td> </tr> <tr> <td>8. Amount due this application</td> <td>$</td> <td>458,122.32</td> <td></td> </tr> <tr> <td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td> <td>$</td> <td>11,736,851.02</td> <td></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: 7/23/2025 PAYMENT OF: $458,122.32 (line 8 or other - attach explanation of the other amount) Recommended by Engineer By: ____________________________ Title: ___________________________ Date: _________________________ Approved by Funding Agency By: ____________________________ Title: ___________________________ Date: _________________________ Approved by Owner By: ____________________________ Title: ___________________________ Date: _________________________ Date: ____________________________ Date: ____________________________