LSJ CONSTRUCTION Subcontractor Payout Project: Laundry #1006 Trade: Tile Flooring Subcontractor Phillip Mark Invoice # Phase # Requisition #01 09-310 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: Insurance ex iration: Partial December 6, 2010 Requisition #01 Final X $6,780.00 $0.00 $0.00 56,780.00 100% $6,780.00 a. Subcontractor/Supplier is liable. explait 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-$0.00 I$0.00 $6,780.00 0 /C- $0.00 None JEE approval attached YES NO X $6,780.00 Invoice Attached YES NO X Approved by: Gary Signed: b Date: Det er 6. 2010 Approved by: Signed: Date EFTA00600532 LSJ CONSTRUCTION Protect Laundry #1006 iboOntraCtor • full legal name: Phillip Mark Phase X 09-310 Trade. roe Flooring Invoice #: Requisition #01 Insurance expiration .Payment Partial Final X nvoire/Recti Date CO Amount Retainage Due Paid Date Paid CheckM Balance Budget Amount 6.780 00 CO01 CO#2 C003 C004 C005 Requisition #1 11/36I10 6.780 00 000 6.780 00 6.780 00 Requisition #2 0.00 Requisition #3 000 Requisition #4 000 Requisition #5 000 Requisition 06 000 Requisition #7 000 Requisition 08 0 00 Requisition 09 000 Requisition #10 0 00 Requisition #11 000 Requisition #12 0.00 Requisition #13 0 00 Requisition #14 0.00 Requisition #15 0.00 Requisition 016 0.00 Requisition #17 0.00 Requisition 018 0.00 Requisition SD 9 0.00 Requisition #20 _ 0.00 Tote 6.780.00 0.00 6.780.00 0.00 6.78000] Date Revised. December 6 2010 Contract Amount - Phase contract CO01 CO02 CO03 CO#4 CONS 6.780 00 Descnption Descnpton Descnption Description Description Contracted To Dale Balance of Contrail wlRetainage 6,780 00 EFTA00600533 EFTA00600534 Emad Hanna From: Monique Harry Sent: Tuesday. December 07. 2010 11 06 AM To: Emad Hanna Subject: Phillip Mark Attachments: Phillip Mark Req 1 1006.pdf Emad, Attached for payment via check Phillip Mark in the amount of $6,780.00. Project 1006 Code 09-310. Monique EFTA00600535