LSJ CONSTRUCTION Subcontractor Payout Project: Master Suite #1004 Trade: Foam Ceiling Moulding Subcontractor Universal Foam, Inc. Insurance ex iration: Janu 0, 1900 Invoice # Phase # 2 06-201 Partial Final X Original Contract Sum: $577.92 Change Orders Submitted & Approved: $1,014.02 New Change Orders: $0.00 Total Work Contracted to Date: $1,591.94 Total Work Completed to Date: 100% $1,591.94 Less Retainage: August 13, 2010 2 Total Payments Made to Date: Total Current Payment Due: $1,014.02 Balance to Finish including Retainage: Sales Tax Liability: $0.00 $577.92 $0.00 a. Subcontractor/Supplier is liable, explaii 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: None JEE approval attached YES NO X Submitted Bill Signed: Date: August 13, 2010 Approved by: Encad Sign / Date: ql\c0 \\O c $1,591.94 Invoice Attached YES NO X Approved by: Gary Signed: Date: August 13, 2010 Approved by: Signed: Date: EFTA00606480