Attachment E - Appendix C - Completion of Inscription Services.pdf
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- 36C78625Q0094
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Appendix C is a certification form for inscription services related to government-furnished headstones, markers, and niche covers for the Department of Veterans Affairs National Cemetery Administration. The form requires a VA contractor to certify completion of inscriptions on specific types of memorial markers and niche covers, including marble and granite variants. The document provides spaces for the contractor to:
- Print their name and sign, verifying inscription completion per contract specifications
- Enter quantities of different marker and niche cover types (Memorial Wall Marker in marble/granite, Niche Cover in marble/granite)
- Include shipment numbers for any rejected items
- Allow a cemetery representative to verify receipt and quantity of items by printing their name and signing the form
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APPENDIX C – COMPLETION OF INSCRIPTION SERVICE(S)
I certify that the inscriptions have been completed per contract specifications on the government furnished headstones, markers, or niche covers identified below.
Printed Name of VA Contractor: _______________________________________________
Signature: _________________________________________ Date: __________________
Check the appropriate box and enter the quantity of the type of headstone, marker or niche cover that has been completed and ready for inspection.
(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: ______
Shipment Number(s) (required) rejects are to be marked:
I certify that the headstones, markers, or niche covers identified above were received by me and the quantity of items has been verified.
Printed Name of Cemetery:_________________________________________________ Signature: _________________________________________ Date: ________________
File details come from the government source that posted it. Updated .