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4 <br /> 3. Expenditures This Period <br /> List actual total expenditures on the last line of the following table. Estimate <br /> expenditures by category as indicated. <br /> Local Fiscal Year Other Fiscal Year <br /> Funds to Date Funds to Date <br /> State CTR Fiscal Year Spent on Local Spent on Other <br /> Funds To Date CTR Funds CTR Funds <br /> Spent State CTR Activities Spent on Activities Spent on <br /> Since Last Funds Since Last CTR Since Last CTR <br /> Categories Report Spent Report Activities Report Activities <br /> Required Activities, $ $ $ $ $ $ <br /> including: <br /> 1. Notification of <br /> New Worksites <br /> 2. Administering <br /> CTR Surveys <br /> 3. Employer <br /> Annual Report <br /> Review <br /> 4. Exemptions and <br /> Modifications <br /> 5. Record <br /> Maintenance <br /> 6. Enforcement <br /> Employer Service Activities <br /> Employer Training $ $ $ $ $ $ <br /> Incentives $ $ $ $ $ $ <br /> Promotion and $ $ $ $ $ $ <br /> Marketing <br /> Guaranteed Ride $ $ $ $ $ $ <br /> Home <br /> Other(Specify) $ $ $ $ $ $ <br /> Totals $ $ $ $ $ $ <br /> 4. Jurisdiction(s) Contact Names,Address,and Phone Numbers <br /> Jurisdiction A John Who City of X PO Box 1234 X, WA 98000 Phone(206)999-9999 <br /> 5. List of contact information for affected worksites in the Jurisdiction. <br /> The information will be submitted in the electronic format approved by WSDOT. <br /> 6. Employer Annual Reports Approved During This Period <br /> Provide the name and worksite identification number for all employer annual reports approved <br /> during this period. Attach a hard copy or electronic(disc)copy of any employer annual reports <br /> approved by the jurisdiction during the quarter. If the jurisdiction approved employer annual <br /> reports submitted via WSDOT's web-based reporting system, indicate the name and worksite <br /> identification number for each worksite report approved. <br /> 2 0 Page 13 . GCA3666 <br />