Attachment D - Appendix B - Transfer of GF Headstones-Markers-NC.pdf
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- Solicitation number
- 36C78626Q0063
About this file
This is an appendix form for transfer of blank government-furnished headstones, markers, and niche covers under VA contract 36C78626Q0063 for on-site inscription services. The form serves as a certification document documenting the handoff of blank memorial items from VA cemetery personnel to a VA contractor.
The form requires cemetery personnel to certify the transfer by providing their printed name, signature, and date, then checking appropriate boxes to document quantities of specific blank items being transferred. The transferable items include memorial wall markers in marble or granite, niche covers in granite or marble, and upright headstones in granite, marble, or marble-granite combinations. The form includes a section for documenting rejected items by type and quantity. Upon receipt, the VA contractor must verify quantities received and provide their printed name, signature, and date to complete the certification. This form functions as an inventory control and accountability document for government-furnished materials provided to the on-site contractor for inscription services.
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Text version
Attachment D – On-Site Inscription Services – 36C78626Q0063
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 .