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

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.: 2 Application Date: 9/26/2025 Application Period: From 7/31/2025 to 9/30/2025 <table> <tr> <th> </th> <th> </th> <th> </th> </tr> <tr> <td>1. Original Contract Price</td> <td>$ 12,182,553.00</td> <td></td> </tr> <tr> <td>2. Net change by Change Orders</td> <td>$ 12,420.34</td> <td></td> </tr> <tr> <td>3. Current Contract Price (Line 1 + Line 2)</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>$ 801,683.84</td> <td></td> </tr> <tr> <td>5. Retainage<br>a. 5% X $ 801,683.84 Work Completed<br>b. 5% X $ ________ Stored Materials<br>c. Total Retainage (Line 5.a + Line 5.b)</td> <td>$ 40,084.19<br>$ -<br>$ 40,084.19</td> <td></td> </tr> <tr> <td>6. Amount eligible to date (Line 4 - Line 5.c)</td> <td>$ 761,599.65</td> <td></td> </tr> <tr> <td>7. Less previous payments (Line 6 from prior application)</td> <td>$ 458,122.32</td> <td></td> </tr> <tr> <td>8. Amount due this application</td> <td>$ 303,477.33</td> <td></td> </tr> <tr> <td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td> <td>$ 11,433,373.69</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: 9/26/25 PAYMENT OF: $ 303,477.33 (line 8 or other - attach explanation of the other amount) Recommended by Engineer By: [signature] Title: Senior Project Engineer Date: 9/29/2025 Approved by Funding Agency By: _______________________ Title: _______________________ Approved by Owner By: _______________________ Title: _______________________ Date: _______________________ Date: _______________________