LSJ CONSTRUCTION Subcontractor Payout Project: Flagpole Pool #1013 Trade: Plaster Subcontractor Phillip Mark Invoice # Phase # Requisition #1 09-200 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: Insurance ex•iration: Ma 14.2012 Partial July 18, 2011 Requisition #1 Final X $11,212.12 $1,899.76 $0.00 $13,111.88 Total Work Completed to Date: 100% $13,111.88 Less Retainage: $0.00 Total Payments Made to Date: $0.00 Total Current Payment Due: $13,111.88 694 Balance to Finish including Retainage: $0.00 Sales Tax Liability: a. Subcontractor/Supplier is liable, explaii Labor and materials 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: $13,111.88 incl. JEE approval attached YES NO X Submitted Bill Signed: Date: July 18. 2011 Approved by: Emad Signed: Date: Invoice Attached YES NO Approved by: Gary Signed: Date: July 18, 2011 Approved by: Signed: Date: EFTA00621644