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.: 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: [Name] Title: Senior Project Engineer Date: 11/26/25 Approved by Funding Agency By: ______________________ Title: ______________________ Approved by Owner By: ______________________ Title: ______________________ Date: ______________________ Date: ______________________