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I <br /> Attachment 5 <br /> REPORT OF SERVICES <br /> Nae of Proj'eet: <br /> m • Month: Year: <br /> Name of Person Performing Services: 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 shownbeloiv•determined? _ <br /> • Labor value appraisal on reverse side of this form. <br /> Didyou-receive any eompensaatio-n frit-the time yon Other,explain: <br /> • devoted to this project? . -.-.------- --- _- ._-_--_—_ <br /> Yes '❑ No ❑ <br /> If yes,who paid you? <br /> How much were you paid? <br /> Total number of hours worked each day duriithis month: <br /> Beginning Sunday Monday Tuesday • Wednesday • Thursday Friday Saturday Totals <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 /> i <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 /> 152 <br />