LSJ CONSTRUCTION Subcontractor Payout Project: Existing Compound Remodel #1009 Trade: Window Treatments Subcontractor Accent on Windows Insurance ex iration: January 0, 1900 Invoice # Req. #1 Partial Final Phase # 12-500 X January 21, 2011 Req. #1 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: $20,575.00 $0.00 $0.00 $20,575.00 Total Work Completed to Date: 50% $10,287.50 Less Retainage: Total Payments Made to Date: $0.00 / v Total Current Payment Due: f $10,287.50 in" -- Balance to Finish including Retainage: 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: JEE approval attached YES NO X Submitted Bill Signed: Date: Janus $10,287.50 None $10,287.50 YES X Invoice Attached NO A Approved by: Ga Signed: Date: January 21, 2011 Approved by: Signed: Date: EFTA00622513