LSJ CONSTRUCTION Subcontractor Payout Project: Main Compound Renovations #1009 January 10, 2011 Trade: Plumbing Requisition #02 Subcontractor Abbott & Lineham Mechanical Insurance ex iration: March 26 2011 Invoice # Phase # Requisition #02 15-400 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: Total Work Completed to Date: Less Retainage: Total Payments Made to Date: Total Current Payment Due: Balance to Finish including Retainage: Sales Tax Liability: Partial X 84% 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 Final $5.000.00 $0.00 $0.00 $5,000.00 $4,200.00 $0.00 $2,850.00 ••••''--- $1,350.00 0/(-- $800.00 I None I Invoice Attached $4,200.00 YES NO X Submitted Bill Signed: Date: January 10, 2011 Approved by: Em d- Signed: Fri-ANS& Date: \ \R1j\ YES X NO Approved by: Gary Signed: Date: January 10, 2011 Approved by: Signed: Date: EFTA00622521