EFTA00609275.pdf

LSJ CONSTRUCTION Subcontractor Payout Project: Main House #1011 Trade: Coral Tile Subcontractor LMT International Insurance ex • iration: January O. 1900 Invoice # Req. #4 Partial Final Phase # 09-601 X October 7, 2010 Req. #4 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: 100% a. Subcontractor/Supplier is liable, explaii 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: $11,350.00 $3,810.50 $0.00 $15,160.50 $15,160.50 $0.00 S13,041.50 $2,119.00 OA.— $0.00 None JEE approval attached YES NO Submitted Bill Signed: Date: Ost.olltr 7. 2010 Emiad oidiA) S15,160.50 Invoice Attached YES NO X Approved by: Ga Signed: October 7, 2010 Approved by: Signed: Date: EFTA00609275 LSJ CONSTRUCTION Project Main House #1011 Supplier - full legal name LSAT iniernationai Phase # 09601 Trade. Coral Tile Invoice /7 Rea a4 Dale Revised October 7. 2010 insurance expiration Payment Partial Final X rP ivoiterReqd ti- dfkLnouni_ CC:01 COQ CONS C004 coos Date CIO Amount Relainage Due Paid Date Paid Cheeldt Balance I 084)5710 08109/10 11 350 00 3.383 00 -.. 427 50 i Revisits:41Ni, Requisition a2 5.675.00 __ _ 1.69150 000 0.00 5.67500 1, 1 50 69 6* 5.675 00 000 C O. 'V t.69150 000 Requisition #3 51175 00 0.00 5.675.00 e 5.6/5.00 000 Regui 11:r 44 _ . Balance 2.11900 0.00 2.119.00 2.11900 _ 2.119(T01 Total j 15.16050 0.00 15.160 50 13.041.50 Contract Amount • Phase CO#1 CCM COI* CON'S CON5 Coral Tile 11.35000 Oisences 3 383 00 DescnPlon PavetS 427 50 Description - DeStnplion Deeciaason Desawnen Contracted to Dale Balance of Contract w/Reteinage isiesso I EFTA00609276 LAM LMT International Invoice No. 154 INTERNATIONAL. .__,_ la es Ir:- ctn Itlbj Deposit Amount Due raytimiet li ner Comments Name 50% Deposit 50% FOB Pod of on9n CC # Expires Thank you for your business I TOTAL $ 3.810.50 THANK YOU FOR YOUR BUSINESS EFTA00609277