LSJ CONSTRUCTION Subcontractor Payout Project: Flagpole Pool #1013 Trade: Pools Subcontractor Virgin Islands Gunite Pools nvoice # Phase # Requisition #6 13-150 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: September 26, 2011 Insurance ex iration: Ma 14, 2012 Partial X Requisition #6 Final $200,000.00 $25,213.44 $0.00 $225,213.44 Total Work Completed to Date: 93% $210,471.25 Less Retainage: Total Payments Made to Date: Total Current Payment Due: Balance to Finish including Retainage: 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 $0.00 $170,471.25 $40,000.00 $14,742.19 incl. Total Outlays for this contract incl. Sales or Use Tax: $210,471.25 ,V) JEE approval attached YES NO X Submitted Bill Signed: Date: September 26, 2011 Approved by: Emad Signed: Date: Invoice Attached YES NO Approved by: Gary Signed: Da : September 26, 2011 Approved/by: Signed: Date: EFTA01123619