Attachment 4 - Initial Headstone-Marker Raise and Realign Verification Survey - Copy.pdf
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- Attached to
- Golden Gate Shrine 895-NS-FY26-001
- Solicitation number
- 36C78626B0024_1
About this file
This is a verification survey form template for the Golden Gate National Cemetery National Shrine Project (FY26) located in San Bruno, California (Project No. 895-NS-FY26-001). The form serves as a quality assurance document to be completed before and after headstone and marker raise and realign work is performed.
The form requires the Contracting Officer's Representative (COR), Cemetery Director, Cemetery Foreman, Work Leader, or designee to conduct an initial survey of all headstones and markers within the scope of work prior to any work commencing. The survey must utilize the Burial Register Report and Gravesite Layout Map(s) to identify discrepancies or issues, document their resolution, and obtain certification via signature and date. Additionally, a Daily Headstone/Marker Raise and Realign Verification Survey must be completed by the same authorized personnel at the end of each workday for all completed work, using the same reference documents. The form includes fields for station number, date, cemetery name, cemetery director identification, COR information, discrepancy documentation, resolution confirmation, and authorized signatory certification. This template is an appendix to the contract documents and does not address specific products, services, pricing, or award terms.
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Text version
Golden Gate National Cemetery National Shrine Project – FY26 San Bruno, CA 94066 Project No.: 895-NS-FY26-001
ATTACHMENT 4
INITIAL HEADSTONE/MARKER RAISE & REALIGN VERIFICATION SURVEY
Station Number: __________________ Date: ______________________________
Cemetery: _______________________ Cemetery Director: ___________________
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.
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