EFTA00609216.pdf

LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal Trade: Water System Subcontractor TSG Technologies, Inc Invoice # Phase # Requisition #02 11-200 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 Insurance ex•iration March • 20 Partial X 50% install only r 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 inci Sales or Use Tax: March 30. 2010 Requisition #02 Final S592,160.00 S0.00 50 .00 5592.160.00 S296.080.00 S0.00 547.800.00 5248,280.00 V V. $296,080.00 None JEE approval attached YES NO Submitted Bill Signed: Date. March 31. 2010 Approved by: Ema Signed: Date. $296.080.00 Invoice Attached YES NO Approved by' Signed: Date: March 31. 2010 Approved by: Signed: Date: EFTA00609216 LSJ CONSTIRL:11 ION tawnier:Kea Sill insurance Proxtd legal name Phase # Trade trirrote e•piralOrt Date MeehanCal nasal SG Tachncloves Inc '1.200 'Amer System ROCuriben 107 I -Mara t Afficunl i Retain:Ice Dare Rev.-serf Moral 30 2010 Date Rape Checka Balance Ilayrneni :nee X Duo Pate Contract Amount 1217700 502 16000 I Cosi CCU: COA3 Ceti Coat Requisition al C2'22 10 Dow! Phase 8- 17.600 043td 0 00 800 00 -aiiroeo 000 Recpsition 12 03i30-10 Procuremqp! - 12% 242111000 j 000 748 280 CO .348 280 00 Zorsibon tt3 Reaey10 Shp 101. 000 Requisition #4 Equip on See : 1. 10' Reqinstbon Substantial Compeller. - &I': 00 Rego-sten /6 Final Compleben - Stt. 790 °tie R3 1 tio lob 080 DO 800 oo. 548 280 00 Contract Amount • Phase CpnoaU Cot? Cue? CCe3 COL, CO:rs RO ;bare Ctentracte1 te Date Flalnece of Contract w Rol ler 507.160 001 • I Dow/Thom I Descnplion • ITibscrieltrei I Description _ . ; Description 592.160 00 NE 080 CO I I EFTA00609217 TSG TSG TECHNOLOGIES INC Pay Request #2 Payment Schedule c Task Percentage l'aymen 5.1; ":,';) O. Sewn Procurenvel - NTP Total per Contract. Less Previously Invoiced: Total this Invoice: , S.'n'A ,1' 100% 5592.160 00 $592.160.00 547,800.00 $248.280.00 Remaining Contract Value. SUI.880.00 40.204.02-PR002 Lane St. James Subtotal Skipping and Handling Taws Total Invoice amount Wire information: TSG Technologies. Inc. Puns Kara. and I teal 5248.280 00 50 .00 5248.280.00 EFTA00609218