LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal #1010 Trade: Excavation Subcontractor Little Buck Trucking Invoice # Phase # Requisition #05 02-200 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: January 27, 2011 Requisition #05 Insurance ex iration: March 1. 2011 Partial X 57% 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: Final $15,000.00 $0.00 $0.00 $15,000.00 $8,500.00 $0.00 $7,000.00 by"' I $1,500.00 lile-- $6,500.00 None JEE approval attached YES NO x Submitted Big Signed: r Date: Janupra7,92.Q11 Approved by: E ad Signed: Date ner 1 )1 i \ $8,500.00 Invoice Attached YES NO x Approved by: Gary Signed: i Date: January 27, 2011 Approved by: Signed: Date: EFTA00622542