None $239,575.00 Invoice Attached YES NO X Approved by: G Signed: Date: June 3, 2010 Approved by: Signed: Date: LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal May 31, 2010 Trade: Concrete Formwork Requisition #03 Insurance ex.iration: March 1, 2011 SubcontractorBig Bear Construction, Inc. Invoice # Phase # Requisition #03 03-120 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 Partial X 29% Final $821,461.00 $0.00 $0.00 $821,461.00 $239,575.00 $11,978.75 $112,931.25 '‘Z -- $114,665.00 ✓ $593,864.75 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: JEE approval attached YES NO Submitted Bill Signed: Date: June 3, 2010 EFTA00722037 LSJ CONSTRUCIION Project Mechanical Dosal ubconlraclor • full legal name: Big Bear Construction. Inc. Phase # 03420 Trade: Concrete Formwork Invoice M: Requisition 103 Date Revised May 31.2010 Insurance expaation. 1-Mar-11 Payment Partial Fla X Invoice/Reset/ Dale 0/0 Amount Relainage Otte Pahl Date Paid Check% Balance Contract Amount 03/11/10 821.48100 CONI COff2 CON3 0014 0015 Requisilion 01 03/31/10 74,400.00 3.720.00 70,680.00 70.880 00 ✓ 0.00 Requisition #2 04130110 44.47500 2.223.75 42,251.25 4225125 ✓ 0.00 Requisition 1/3 Requisition #4 05/31/10 120 70000 6.035.00 114 80500 114,865.00 0.00 - 0.00 Requisition 115 0.00 - Requisition #6 0.00 - Requisition #7 900 - Requisition #8 0.00 - Requisition 09 0.00 • Total 1230.57600 11.978.76 227,69926 112,931.25 114,665.00 Contract Amount - Phase Contract C001 CON COM3 COM4 COM Concrete Formwork Coneacled To Dale Balance 01Contract wiRelainage EFTA00722038 APPUCATION AND CERTIFICATION FOR PAYMENT ALA DOCUMENT G7O2 TO 000411. 0101/ CONTRA0700. LS:WC P7Olted NN QOM 03 non y9A 00802 •0 Yr Sc %** Ems Oct.. Pt. fle .Ww. USW 0000 TIOJEC, AI eO4.441Pas 3.brqi10,0 Coran.ccovatoger 4 001)04MM 00 Axacmai >et ores fro.. BMOC TO 'BOAC! • 91)2010 54142010 51010 WE • M MASeil r 0 wwwww r — lLewtiwwn Weeps. CONTRACTORS APPUCADON FOR PAYMENT atolcaoo ono& ter carom as noon pea. o cove< tea ors to Oa= Conentoxo Sten MA Coacusea4703.0 acct.* kaiwn. twins Ossome. WO•W•0 tiserrOW.1.4 wands., 46 .0 a Oa Aloha's>, V Payokot Nf tan coreploliall n Beorsirco•Ot ..scuts 000.10e. Owl al woo* Pos won Slew ColPIOW I. NSA IV MSS yeACY Calfral• v rowan min spas ace arson MOW/ frown acct. ace m Wan 0WWWW 00.0 sans tow Oa 00:43INAL CONTRACT SIM $121.461 00 CONTRACTOR: 2. t4tt000go ty04 494 Wets 5000 1 CONTRACT SUM TO OATS Mho 41) $521.461 00 By (54 Beat Cons MAW IC OMB 5131/2010 4 TOL% COMPLETED & STORED TO t2141.575 00 DATE (COlona Go VIEW 5. RELONAGE 02% CorrOitiaW00i *SS Balaton Casa D.5400703: 5 OA X." Stat.:04nel (Colon *nom Tool R000ne :U•44 Sa • 513e4 Toot n Coln rd0 7m1 6. 40 7/4. EARNED LESS l*L 4.44.4.CQ et 4 Les Leo 5 Tool LESS POEM:WS CifiliFCATES FOR PAYuENT (Lew 6 Irmo, CAftto.mtl C1.01AVIT PAYMENT DUE I BALANCE TO F0.001. wawa° neweass erne 3 leSS LW. 00 511 IM TS_ $000 III In 7$ 5222 55625 Soo 4. Catty as subsea w .en le YVAN/ emi u. S WON Publa W Cwwwwwwwwt CERTIFICATE FOR PATINWF sius " ', Co peopoloa we} PO Cann Dicynin. rut to Mom *Srsons aro so Ma tovotoolos ttOcomo The Covotoonorolo sots ▪Crow Ix nas loolatilo Cosolon1441•14444•4104114144. Wootat*.inp W is Wen on SPOInsio• outs OW east Of to WC" S114.66S03 • 40024rdfle .moo. Cam COMMON /Mee G.Oaa>s'MOO <4 04.4.vOthTCERTAEO MOM , O CANOE ORDER Sulam/1Y *canapes DECOCTIONS Too Mgt. lettood o 4~04 toal4 Or (Now. 5000 tom Tow 44,C4P40 On Moon $000 SOCA TOTALS SOOT SOO NET coanGgS Dy ClOtb)4 COW 50 00 AMOUNT CEAPRED III 4144 00 WOO. SO.Inko I Conrad ass Ina is ocoOprs SP O. sestartaRfee0 wObwo 'ys to ktokaw Csonetan Yen gat me st Coto: !sondes • ea enema*. Ti. 0A.0.00 Crt•nnOO • 0www any N.V. Ceramic. nay hem tuasco 0.•••••• OM •fterPOrco al Po PoP tast OfolOOM Pot albs d Os Oa of Omer ins as Canna AM (*Wart! Gra? AtoUCA, 0 1NO monneArKA 140.041.1 IC (WNW mA O. Users otyotoon vabt4tion d tins 410Cu RAI by tequestog • comated AN Daum:of 0401 . Cotitt.ation ot Pocono. i`s Authenticity Wore Mt LiCtit MM. 0A0U0CAN mann" OF NCO MIS UM .C'W YORK 4N Nw wAIWALO !Olt CC ECCCWOM Su:mow Shea I of I EFTA00722039 CONTINUATION SHEET NA DOCUMENT G703 ALA Document G702. APPLICATION AND CERTIF)CATION FOR PAYMENT. conlanng APPLICATION NO: 3 Contractors signed cerbficaion .5 attached. APPLICATION DATE: 05724/10 In tabulation Woo. amounts are stated to the nearest dollar. PERIOD TO: 05.1-31/10 Use Worm Ion Contracts where variable retaage ice line .cams may apply A 8 C 0 I E F G H I ITEM NO. DESORPTION OF WORK SC/IV:PLIED VALUE WORK COMPLETED mATERIMS PRESENTLY STORED (NOT IN 0 & El OGRE) TOTAL 001WLETE0 AND STORED TO DATE (D•E•FI % (G-0) BALANCE TO FN151i (C • 0) RETAriAGE ('S VARIABLE RATE) F11014 PREVIOUS APOL)CATiON (0 - E) THIS PERIOD 00001 Snrxing Refit* $65.350.00 50.00 $68.350.00 50.00 568.350.00 100.00% $0 .00 3417.50 00002 Tots and Accessorise 526.500 00 $20000.00 $0.00 50.00 320000.00 70.18% $8.9)0.00 1000 00 00003 Form Rental $23.500.00 $23.500.03 $0.00 $0.00 523.500.00 100.00% $0.00 1175.00 00004 insurance 13.500.00 15.500.00 $0.00 $0.00 58.500.00 140.07% $0.00 425.00 00005 Fraght 519.500.00 $15.000.03 $0.00 $0 .00 515.000.00 76.92% 54.500.00 750.00 00006 F.:tuning PABIereaS 15.000.00 $0.00 $1.000.00 $000 $1000.00 20.00% $4.030.03 50.00 00007 Misc. Maaerials 510.000.00 5000 $1.000.00 $0.00 $1,000.00 10.00% $9.00000 50 00 00006 ?Esc. Sue Work 530.750.00 $3.075.00 $0.00 $0.00 $3,075.00 10.00% 521.675.00 153.75 00009 Bast Slab Form 516700 00 $15.000.00 51.700.00 30 00 $16.700.00 100.00% 50.00 835.00 00010 Base Slab Reinforcing $34.800.00 517.430.00 517.400.00 $0.00 $34.803.00 100.00% $0.00 1740.00 00011 Base Slab Post $1950.00 50.00 $5.950.00 SO 00 55.950.00 100.00% $0.00 297.50 00012 Base Wals Form $56.300.00 $0.00 $5.630.00 $0.00 $5.1300.00 10.00% $50.670.00 281.50 00013 Base Wats Ronforcung 532.700.00 $0.03 53.270.00 30.00 53.270.00 10.00% $29.430.00 163.50 00014 Base Wats Pour $6.300.00 $0.03 $0.00 50.00 50.00 0.00% 56.300.00 0.00 00015 1s•. Elevated Slab Form $41.95000 $0.00 $0.00 50.00 50.00 0.00% $41.950.00 0.00 00016 is Elevated Slab Remkscog 537.250.W $0.00 $0.00 SOW $0.00 0.00% 537.250.00 0.03 00017 ist Elevated Saab Poor $8.400.00 50.00 $0.00 $0.00 50.00 0.00% 58.400.00 0.00 00018 1st Fl. Was Form 579.000.00 $0.00 MOO S000 50.00 0.00% 579.0)0.00 003 00019 1st FL Wags Reinke:mg $41.700.03 $0.00 $0.00 $0.00 $0.00 0.00% $41/00.00 000 00020 ist FL Wan Pour $3.60000 10.00 10.00 $0.00 50.00 0.00% $5.600.00 00 00021 Roof Slab Form $54.65000 $0.00 50.00 5000 $0.00 0.00% 554.650.00 000 00022 Roof Slab Roc/forcing $42.500.00 50.0 50.00 $0.00 50.00 0.00% 542,500.00 0.00 00023 Roof Slab Pew 59.100.00 $0.09 5000 $0.00 50.00 0.00% 59.10000 0.00 00024 Parapet Wall Form 511.450.00 $0.00 50.00 50.00 50.00 0.00% S11.450.03 0.00 00025 Parapet wall Reinforcing 52.800.00 $0.00 50.00 $0.00 50.00 0.00% 52.800.03 0.00 00026 Parapet wail Pour $3.300.00 50 .00 30.00 $0.00 $0.00 0.00% 53.300.00 0.00 00027 °whose $34.22800 54.100.00 54.10 .0 50.00 58.200.00 23.96% 526 028 03 4)000 00028 Profit 5102.683.00 512.300.00 512.300.00 50.00 $24.60300 23.96% 578.083.00 1230.00 00029 S0.0 $0.00 $0.00 $0.00 IDNIO! $0.03 0.00 00030 $0 .0 $0.00 $0.00 $0.00 SON10! $0.00 0.00 00031 $0.00 $0.00 $0.00 $0.00 /tC4V43! $0.00 0.00 00032 $0.00 $0.00 $0.00 $0.00 4C4WO! $0.00 0.00 GRAND TOTALS $82'.461.0 511887500 $120.700.03 $OW $239575.0 29.16% 5581 886.03 511.978.75 EFTA00722040