Attachment D - Appendix B - Transfer of GF Headstones-Markers-NC.pdf
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- Solicitation number
- 36C78626Q0057
About this file
This is an appendix form used for documenting the transfer of blank government-furnished headstones, markers, and niche covers from VA cemetery personnel to VA contractors providing on-site inscription services under contract 36C78626Q0057.
The form serves as a certification and accountability document requiring signatures from both cemetery personnel and the receiving VA contractor. Cemetery personnel certify the transfer of blank items by product type and quantity, which include memorial wall markers in marble or granite, niche covers in granite or marble, and upright headstones in granite, marble, or combination marble/granite. The form includes a section for documenting rejected items by type and quantity. The VA contractor receiving the materials must certify receipt and verify the quantities match those transferred. Both parties must provide printed names, signatures, and dates to complete the form, establishing a documented chain of custody for government-furnished materials used in inscribing services at VA cemeteries.
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Text version
Attachment D – On-Site Inscription Services – 36C78626Q0057
APPENDIX B - TRANSFER OF BLANK GOVERNMENT-FURNISHED HEADSTONES,
MARKERS, OR NICHE COVERS
I certify that the blank headstones, markers, or niche covers specified below were transferred to the VA contractor listed at the bottom of the form.
Printed Name of Cemetery Personnel:
Signature: ____________________________________ Date: _________________________
Check the appropriate box and insert the quantity for the type of headstone, marker or niche cover being transferred to the on-site contractor.
(A1) Memorial Wall Marker, Marble, Blank Quantity: ______
(C1) Memorial Wall Marker, Granite, Blank Quantity: ______
(H1) Niche Cover, Granite, Blank Quantity: ______
(I1) Niche Cover, Marble, Blank Quantity: ______
(W1) Headstone, Upright, Granite, Blank Quantity: ______
(U1) Headstone, Upright, Marble, Blank Quantity: ______
(V1) Headstone, Upright, Marble, Granite, Blank Quantity: ______
(W1) Niche Cover, Granite, Blank Quantity: ______
List any rejects below, include type and quantity:
I certify that the headstones, markers, or niche covers specified above were received by me and the quantity of items has been verified.
Printed Name of VA Contractor:
Signature: _______________________________________________ Date: _______________
File details come from the government source that posted it. Updated .