EFTA00622439.pdf

LSJ CONSTRUCTION Subcontractor Payout Project: Existing Compound Renovations #1009 August 16, 2010 Trade: Roofing Assembly Requisition #01 Subcontractor Matthew Jarvis Insurance ex iration: December 31, 2010 Invoice # Requisition #01 Partial Final Phase # 07-412 X Original Contract Sum: $13,440.00 Change Orders Submitted & Approved: $0.00 New Change Orders: $0.00 Total Work Contracted to Date: $13,440.00 Total Work Completed to Date: 100% $13,440.00 Less Retainage: $0.00 Total Payments Made to Date: $0.00 Total Current Payment Due: $13,440.00 -/ Balance to Finish including Retainage: $0.00 Sales Tax Liability: a. Subcontractor/Supplier is liable, explaiiinstall only / tax included in contract b. Non-resident Subcontractor/Supplier Bond Applicable: c. Use Tax to be paid by our company: d. Shipping None Total Outlays for this contract incl. Sales or Use Tax: $13,440.00 JEE approval attached Invoice Attached YES NO YES NO X X Submitted Bill Approved by: Gary Signed: Signed: Date: August 16, 2010 Date: August 16, 2010 Approved by: Emad Approved by: Signed: Signed: Date: 1110 Date: EFTA00622439 LSJ CONSTRUCTION Project Existing Compound Renovations #1009 Supplier rue meal name. Matthew Jarvis Date Revised August 16, 2010 Phase # 07.412 Trade Roofing Assembly Invoice A: Requtsition #01 !nuisance expiration 31.Des-10 Payment Partial Final X Date CrO Amount Miln Due Paid Date Paid Cheddi CIE.. P.O. Amount 0//2-9/ I 0 11440.00 C011 CON2 con con DOSS Ftequisition #1 0n27/10 MI FlashIn0s 13.440.00 13.440.00 Requisition #2 0.00 Requisibon #3 0.00 — isition 114 ®® 0.00 Total 11440.00 0.00 13,440.00 0.00 13.440.001 Contract Amount - Phase PO Metal Fisehino4 11440.00 C041 DIPS010041 COO Descripbon CO#3 DesChption CO#4 DreaMtion CONS Description Contracted To Date 13.440.00 Balance of Contract wrRetainece EFTA00622440 EFTA00622441 EFTA00622442 EFTA00622443