36C78620Q0185-016.docx

ATTACHMENT O

INITIAL HEADSTONE/MARKER RAISE & REALIGN VERIFICATION SURVEY

Contracting Officers Representative: ______________________________________ Instructions: The Contracting Officer’s Representative (COR) /Cemetery Director/Cemetery Foreman/ Work Leader/designee MUST conduct an initial survey of ALL headstones/markers included in the scope of work (SOW) before any work is performed. The COR/Cemetery Director/Cemetery Foreman/Cemetery Work Leader/designee will use the Burial Register Report and the Gravesite Layout Map(s) for the initial survey.

Discrepancy/Issue Identified: Y/N_______ Date: ____________________ All discrepancies/issues resolved Y/N ________ Date: ____________________ I certify that the Initial Headstone/Marker verification survey was completed by the COR/Cemetery Director/Foreman or Work Leader/designee. The Burial Register Report and the Gravesite Layout Map for the Cemetery and sections listed in the SOW were used to complete the survey.

COR/Director/Foreman/Work Leader/designee Signature: ______________________ Date: _________________ Prior to the completion of the workday, a Daily Headstone/Marker R&R Verification Survey MUST be completed by the COR/Cemetery Director/Cemetery Foreman/Work Leader/designee utilizing the same Burial Register Report and Gravesite Layout Map as used in the initial survey for ALL completed work.