LSJ CONSTRUCTION Subcontractor Payout Project: Island Trails #1012 Trade: Stonework Subcontractor Rodney Rusphille Invoice # Phase # Requisition #1 04-450 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: 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 June 22, 2011 Requisition #1 Insurance expiration: January 0, 1900 Partial X Final $50,000.00 $0.00 $0.00 $50,000.00 53% $26,700.24 $0.00 I $0.00 $26,700.24 $23,299.76 incl. Total Outlays for this contract incl. Sales or Use Tax: $26,700.24 JEE approval attached YES NO X Submitted Bill Signed: Date: June 22. 2011 Approved by: Emad Signed: Date: Invoice Attached YES NO X Approved by: Gary Signed: Date: June 22, 2011 Approved by: Signed: Date: EFTA_R1_02031913 EFTA02690921