Attachment D - Appendix B - Transfer of GF Headstones-Markers-NC.pdf

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Attached to
L099--Onsite Inscription Services for Jefferson Barracks National Cemetery
Solicitation number
36C78626Q0122
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This document is a template form for transferring blank government-furnished headstones, markers, or niche covers from VA cemetery personnel to VA contractors performing on-site inscription services.

The form documents the transfer of various types of blank memorial products, including memorial wall markers (marble and granite), flat markers (marble and granite variants), niche covers (granite and marble), and upright headstones (marble and granite). Cemetery personnel certify the transfer by providing their printed name, signature, and date, while specifying the quantity of each product type being transferred. The form includes a section for documenting rejected items by type and quantity. The VA contractor receiving the items verifies receipt and confirms that quantities have been verified by providing their printed name, signature, and date. This form serves as an accountability document for tracking government-furnished materials used in the inscription services contract.

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Other files

File Type Posted
Attachment F - Drawings.pdf PDF
36C78626Q0122.docx DOCX document
Attachment I - CDR.pdf PDF
Attachment E - Appendix C - Completion of Inscription Services.pdf PDF
Attachment C - Appendix A - Cemetery Site Specific Info and Maps.pdf PDF
Attachment B - SOW - 0122 On-Site Inscription Services - Jefferson Barracks.pdf PDF
Attachment A - Price-Cost Schedule - 0122 On-Site Inscription Services - Jefferson Barracks.xlsx XLSX spreadsheet
Combined Synopsis Solicitaton - 0122 - On-Site Inscription Services - Jefferson Barracks NC.docx DOCX document
Attachment K - Past Performance Questionnaire - 0122.docx DOCX document
Attachment J Sample Review Forms.pdf PDF
Attachment H - Weekly Status Report Sample.pdf PDF
Attachment G - WD 2015-5075 Rev 34 - 22 Aug 2026.pdf PDF
Show all 12

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Attachment D – On-Site Inscription Services

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: ______

(F1) Marker, Marble, Blank Quantity: ______

(H1) Niche Cover, Granite, Blank Quantity: ______

(I1) Niche Cover, Marble, Blank Quantity: ______

(J1) Thin Flat Marker, Granite, Blank Quantity: ______

(L1) Small Flat Marker, Granite, Blank Quantity: ______

(U1) Headstone, Upright, Marble, Blank Quantity: ______

(V1) Headstone, Upright, Marble, Blank Quantity: ______

(W1) Headstone, Upright, 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 .