LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal #1010 Trade: Excavation Subcontractor Little Buck Trucking Invoice # Phase # Requisition #04 02-200 January 21, 2011 Requisition #04 Insurance ex iration: March 1. 2011 Partial X Final Original Contract Sum: $15,000.00 Change Orders Submitted & Approved: $0.00 New Change Orders: $0.00 Total Work Contracted to Date: $15,000.00 Total Work Completed to Date: 47% $7,000.00 Less Retainage: $0.00 y Total Payments Made to Date: $5,000.00 Total Current Payment Due: $2,000.00 OK- Balance to Finish including Retainage: $8,000.00 Sales Tax Liability: a. Subcontractor/Supplier is liable, explair 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: $7,000.00 None JEE approval attached YES NO X Submitted Bill Signed: Li Date: January , 201 I M c Approved by: E d , Signe : \ X\ Dat : Invoice Attached YES NO X Approved by: Ga Signed: Date: January 21, 2011 Approved by: Signed: Date: EFTA00622538