Packet: Regular Formal Council Meeting (10/07/2025)

Contractor's Application for Payment Owner: City of Tiffin Owner's Project No.: Engineer: | MSA Professional Services Engineer's Project No.: 13603016 Contractor: Tricon Construction Group Contractor's Project No.: Project: Water Treatment Plant Upgrades - City of Tiffin Contract: Water Treatment Plant Upgrades Application No.: 2 Application Date: 9/26/2025 Application Period: From 7/31/2025 to 9/30/2025 1. Original Contract Price $ 12,182,553.00 2. Net change by Change Orders $ 12,420.34 3. Current Contract Price (Line 1 + Line 2) $ 12,194,973.34 4. Total Work completed and materials stored to date S 801,683.84 (Sum of Column G Lump Sum Total and Column G Unit Price Total) $ 801,683.84 5. Retainage a 5% X $ 801,683.84 Work Completed $ 40,084.19 b 5% X §$ - Stored Materials $ - c. Total Retainage (Line 5.a + Line 5.b) $ 40,084.19 6. Amount eligible to date (Line 4 - Line 5.c) $ 761,599.65 7. Less previous payments (Line 6 from prior application) $ 458,122.32 8. Amount due this application $ 303,477.33 9. Balance to finish, including retainage (Line 3 - Line 4, plus 5c) $ 11,433,373.69 Contractor's Certification The undersigned Contractor certifies, to the best of its knowledge, the following: Contractor: T/;con Cons triton Group Signature: nam VK. Ste Date: lao 7 7 /2=- “7 ["~ 4 iil 7 PAYMENT OF: $ 303,477.33 (line 8 or other - attach explanation of the other amount) Recommended by Engineer Approved by Owner By: fit Oeene— By: Title: Senior Project Engineer Title: Date: 9/29/2025 Date: Approved by Funding Agency By: By: Title: Title: Date: Date: EJCDC® C-620 Contractor's Application for Payment © National Society of Professional Engineers for EJCDC. All rights reserved. 00 62 7B sehVOR\dnares\Projects\Active\ Tiffin WTP. (25-012-IA)\3-Tricon\PaymentApplications\Pay Application