LSJ CONSTRUCTION Subcontractor Payout Project: Master Suite #1004 Trade: Granite Countertops January 10, 2011 Requisition #01 Subcontractor Virgin Islands Granite & Marble Insurance ex 'ration: January o. 1900 Invoice # Phase # Requisition #01 12-310 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: $1,870.85 $0.00 $0.00 $1,870.85 Total Work Completed to Date: 50% $935.43 Less Retainage: Total Payments Made to Date: Total Current Payment Due: $935.43 Balance to Finish including Retainage: $935.42 Sales Tax Liability: $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: $935.43 $0.00 None JEE approval attached YES NO X Submitted Bill Signed: Date: January 10, 2011 Approved by: Emad Signed: Date: \ \\ CA\\ invoice Attached YES NO X Approved by: Gary Signed: Approved by: Signed: Date: EFTA00606490