LSJ CONSTRUCTION Subcontractor Payout Project: Laundry #1006 Trade: Tile Flooring Subcontractor Phillip Mark Invoice # Phase # Requisition #01 09-310 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: Total Work Completed to Date: Less Retainage: Total Payments Made to Date: Total Current Payment Due: Balance to Finish including Retainage: Sales Tax Liability: Insurance ex iration: Partial December 6, 2010 Requisition #01 Final X $6,780.00 $0.00 $0.00 56,780.00 100% $6,780.00 a. Subcontractor/Supplier is liable. explait install only / tax included in contract b. Non-resident Subcontractor/Supplier Bond Applicable: c. Use Tax to be paid by our company: d. Shipping Total Outlays for this contract incl. Sales or Use Tax- $0.00 I $0.00 $6,780.00 0 /C- $0.00 None JEE approval attached YES NO X $6,780.00 Invoice Attached YES NO X Approved by: Gary Signed: b Date: Det er 6. 2010 Approved by: Signed: Date EFTA00600532