LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal Trade: Water System Subcontractor TSG Technologies, Inc nvoice # Phase # Requisition #04 11-200 December 28, 2010 Requisition #04 Insurance ex tration: March 1.2011 Partial X Final Original Contract Sum: $592.160.00 Change Orders Submitted & Approved: $1,000.00 New Change Orders: $0.00 Total Work Contracted to Date: $593,160.00 Total Work Completed to Date: 90% $533.944.00 ./ Less Retainage: $0.00 Total Payments Made to Date: $473,728.007 Total Current Payment Due: $60,216.00 Balance to Finish including Retainage: $59,216.00 Sales Tax Liability: 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 None Total Outlays for this contract incl. Sales or Use Tax: JEE approval attached YES NO X Submitted Bill Signed: Date: De.rber_28, 2010 mad Approved b E Sig d: r iga D te: 1?-•\A‘V $533.944.00 Invoice Attached YES NO X Approved by: Gary Signed: Date: December 28, 2010 Approved by: Signed: Date: EFTA00609225