Approval of State Revolving Fund (SRF) Reimbursement Request #10 - Water Treatment Facility Upgrade Project — E-5

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.: 14R Application Date: 10/23/2026 Application Period: From 9/25/2026 to 10/23/2026 <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>57,799.31</td> <td></td> </tr> <tr> <td>3. Current Contract Price (Line 1 + Line 2)</td> <td>$</td> <td>12,240,352.31</td> <td></td> </tr> <tr> <td>4. Total Work completed and materials stored to date<br>(Sum of Column G Lump Sum Total and Column G Unit Price Total)</td> <td>$</td> <td>10,772,645.47</td> <td></td> </tr> <tr> <td>5. Retainage<br>a. 5% X $ 10,440,899.11 Work Completed<br>b. 5% X $ 331,746.36 Stored Materials<br>c. Total Retainage (Line 5.a + Line 5.b)</td> <td>$</td> <td>522,044.96<br>16,587.32<br>538,632.28</td> <td></td> </tr> <tr> <td>6. Amount eligible to date (Line 4 - Line 5.c)</td> <td>$</td> <td>10,234,013.19</td> <td></td> </tr> <tr> <td>7. Less previous payments (Line 6 from prior application)</td> <td>$</td> <td>9,699,565.50</td> <td></td> </tr> <tr> <td>8. Amount due this application</td> <td>$</td> <td>534,447.69</td> <td></td> </tr> <tr> <td>9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c)</td> <td>$</td> <td>2,006,339.12</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: 10-29-2026 PAYMENT OF: $534,447.69 (line 8 or other - attach explanation of the other amount) Recommended by Engineer By: Clint White Title: Senior Project Engineer Date: 10/29/2026 Approved by Funding Agency By: Title: Approved by Owner By: Title: Date: ____________________________ Date: ____________________________