EFTA00600532.pdf

LSJ CONSTRUCTION Subcontractor Payout Project: Laundry #1006 December 6, 2010 Trade: Tile Flooring Requisition #01 Subcontractor Phillip Mark Insurance ex iration: Invoice # Requisition #01 Partial Final Phase # 09-310 X Original Contract Sum: $6,780.00 Change Orders Submitted & Approved: $0.00 New Change Orders: $0.00 Total Work Contracted to Date: 56,780.00 Total Work Completed to Date: 100% $6,780.00 Less Retainage: $0.00 Total Payments Made to Date: $0.00 Total Current Payment Due: I $6,780.00 $0.00 0 /C- Balance to Finish including Retainage: Sales Tax Liability: install only / tax a. Subcontractor/Supplier is liable. explait 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- $6,780.00 JEE approval attached Invoice Attached YES NO YES NO X X Approved by: Gary Signed: Date: Det b er 6. 2010 Approved by: Signed: Date EFTA00600532 LSJ CONSTRUCTION Protect Laundry #1006 Date Revised. December 6 2010 iboOntraCtor • full legal name: Phillip Mark Phase X 09-310 Trade. roe Flooring Invoice #: Requisition #01 Payment Insurance expiration. Partial Final X Due Paid Date Paid CheckM Balance nvoire/Recti Date CO Amount Retainage Budget Amount 6.780 00 CO01 CO#2 C003 C004 C005 000 6.780 00 6.780 00 Requisition #1 11/36I10 6.780 00 0.00 Requisition #2 000 Requisition #3 000 Requisition #4 000 Requisition #5 000 Requisition 06 000 Requisition #7 0 00 Requisition 08 000 Requisition 09 0 00 Requisition #10 000 Requisition #11 0.00 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 6.780.00 0.00 6.78000] Tote 6.780.00 Contract Amount - Phase contract 6.780 00 CO01 Descnption CO02 Descnpton CO03 Descnption CO#4 Description CONS Description Contracted To Dale 6,780 00 Balance of Contrail wlRetainage 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