2007/10/31 Council Agenda Packet

• Attachment 5 5 REPORT OF SERVICES Name.of Project: Month: Year: Name of Person Performing Services: Describe the services you performed.(If you supervised others,include their names and positions.) Address: Telephone: How was the hourly rate shown below determined? ❑ Labor value appraisal on reverse side of this form. Did you receive any compensation for the time you ❑ Other,explain: devoted to this project? Yes El NQ ❑ If yes,who paid you? How much were you paid? Total number of hours worked each day during this month: Beginning Sunday Monday Tuesday Wednesday Thursday Friday Saturday Totals I hereby swear that I devoted the time reported above,performing the Total hours this #of hours work described on the project named. This time has not been•reported month: for any other Federal 0;State project. Hourly rate: $ Per hour Date Amount charged to $ I buperviseds or coordinated this person's work and verify that it was - project: performed as indicated above. Date INSTRUCTIONS: Washington State Office of Archaeology and Historic Preservation Use this form to document alllat or,whether paid or 1063 S.Capitol Way,Suite 106 voluntary,which is claimed against a grant or used PO Box 48343 for the matching share of a grant. Complete it on a Olympia,WA 98504-8343 timely basis,i.e.,fill itoutimmediately after the service is provided. • 33 2003 Reprint.