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16 <br /> Attachment 5 <br /> REPORT OF SERVICES <br /> Name of Project: Month: Year. <br /> Name of Person Performing Seaeices: Describe the services you performed.(If you supervised others,include their names <br /> - and positions.) <br /> Address: <br /> Telephone: <br /> How was the hourly rate shown below determined? <br /> Labor value appraisal on reverse side of this form. <br /> Did you receive any compensation for the time you Other,explain: <br /> devoted to this project? <br /> Yes ❑ No ❑ <br /> If yes,who paid you? -•- <br /> How much were you paid? ' <br /> _ - ❑ <br /> Total number of hours worked each day durirci this month: <br /> Beginning Sunday_ Monday Tuesday Wednesday Thursday Friday Saturday Totals <br /> _ 3 , <br /> I hereby swear that I devoted the time reported above,performing the Total hours this #of hours <br /> work described on the project named. This time has not been reported month: <br /> for any other Federal or State project <br /> Hourly rate: $ Per hour <br /> Date <br /> Amount charged to <br /> I supervised or coordinated this person's work and verify that it was project: <br /> performed as indicated above. . <br /> Date. <br /> INSTRUCTIONS: <br /> Washington State Office of Archaeology and Historic Preservation Use this form to document all labor,whether paid or <br /> 1063 S.Capitol Way,Suite 106 voluntary,which is claimed against a grant or used <br /> PO Box 48343 for the matching share of a grant. Complete it on a <br /> Olympia,WA 98504-8343 timely basis,i.e.,fill it out immediately after the <br /> service is provided. <br /> 2003 Reprint <br /> 117 <br />