Discussion and Consideration of Pay Application #6 – Miron Construction, Recreation Center – Motion to Approve

APPLICATION AND CERTIFICATE FOR PAYMENT Page: of 4 TO OWNER: City of Tiffin PROJECT: City of Tiffin Community Recreation Center 300 Railroad St 105 S Park Road APPLICATION NO.: 6 Distribution to: Tiffin, IA 52340 Tiffin, IA 52340 PERIOD TO: 10/31/2025 [JowNER USA USA □ PROJECT NOS.: 250120 [] ARcrrEecT ARCHITECT:Atura Architecture INVOICE NO.: 250120-0006 CONTRACTOR □ FROM Miron Construction Co., Inc. CONTRACTOR: PO Box 1372 912 North 13th Street Green Bay, WI 54305-1372 Clear Lake, IA 50428 CONTRACT DATE : 11/19/2024 □ CONTRACT FOR:Ctyof Tiffin Community Recreation Center APPLICATION AND CERTIFICATE FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts Application is made for payment, as shown below, in connection with the Contract. Continuation sheet have been paid by the Contractor for Work for which previous Certificates for payment were issued and payments received is attached. from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM . $ 12,435, 142.00 WARNING: DO NOT CHANGE ESTABLISHED PAYMENT INSTRUCTIONS FOR PAYMENTS TO MIRON 2. Net change by change orders . -1,042,001.88 CONSTRUCTION CO., INC.. Miron Construction Co., Inc. does not change its bank routing or account numbers. Do not $ accept or rely upon emails or correspondence requesting changes to Miron Construction Co., lnc.'s established payment 3. CONTRACT SUM TO DATE ( Line1 +/-2)..... $ 11,393,140.12 instructions. Any change to Miron Construction Co., lnc.'s payment instructions can only be made by a fully executed 4. TOTAL COMPLETED & STORED TO DATE .... 2,417,411.86 Change Order to the Agreement between Owner and Miron Construction Co., Inc.. $ (Column G on G703) Contracto(;..-M~struction Co., Inc. 5. RETAINAGE: (Total retainage Column I of G703) $ 120,870.60 • «p,2 Date: rs,,, .2"7 October 23. 2g28,,,are -.-, e:,"-,r;:::.;~~,u~~ c l- 'r, 6. TOTAL EARNED LESS RETAINAGE.......... $ 2,296,541.26 State of: Wisconsin 385.-° '· (Line 4 less Line 5 Total ) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT County of: Winnebago 2ow,jg ;5 : Subscribed and sworn to before a (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE................ $ $[ 712 316.58 1,584,224.68 me this 23 g;fr: A Ea%Mj 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6 ) CHANGE ORDER SUMMARY (Change Order approved in ADDITIONS $ Notary Public: 9,096,598.86 My Comm;sskm expl,esc DEDUCTIONS ~ ARCHITECTS CERTIFICATE FOR PAYMENT Q \DJ{,} Z.ID = =:.: ~·- WISC/' OFa ' a5Gs---' . _/ ~ ~$ 0.00 -1,042,001.88 previous months by Owner In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, APPROVED THIS MONTH the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to Number Date Approved the payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED........................................$ (Attach explanation If amount certified differs from the amount applied for. Initial figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) By: City of Tiffin Current Total 0.00 0.00 ARCHITECT: Atura Architecture Net Change by Change Orders -1.042 001.88 By: Date: AIA Document G702 -- 1992.Copyright 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this ALA This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced at 13:18:53 on 10/23/2025 under Order No 20240046063 which expires on 07/24/2026, and Is not for resale. User Notes: payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.