Attachment E - Appendix C - Completion of Inscription Services.pdf
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- 36C78626Q0124
About this file
This is a completion certification form for on-site inscription services on government-furnished headstones, markers, and niche covers used in Veterans Affairs cemetery operations.
The form serves as an attestation document requiring certification from two parties: cemetery personnel and a VA contractor. Cemetery personnel must certify that inscriptions have been completed per contract specifications and document the quantities of completed items by type, including memorial wall markers (marble or granite), flat markers (marble, thin granite, or small granite), niche covers (granite or marble), and upright headstones (granite, marble, or combination marble-granite). The form requires personnel to list any rejected items with their type and quantity. The VA contractor subsequently certifies receipt of the specified headstones, markers, or niche covers and verifies the quantity of items received. Both certifications require printed names, signatures, and dates. This form is designed to track completion and delivery milestones for inscription services on government property used in veteran memorialization.
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Attachment E – On-Site Inscription Services
APPENDIX C – COMPLETION OF INSCRIPTION SERVICE(S)
I certify that the inscriptions have been completed per contract specifications on the government-furnished headstone, markers, or niche covers identified below:
Printed Name of Cemetery Personnel: ______________________________________________ Signature: ____________________________________ Date: _________________________
Check the appropriate box and insert the quantity for the type of headstone, marker or niche covers that has been completed and ready for inspection:
(A1) Memorial Wall Marker, Marble, Inscribed Quantity: ______
(C1) Memorial Wall Marker, Granite, Inscribed Quantity: ______
(F1) Marker, Marble, Inscribed Quantity: ______
(H1) Niche Cover, Granite, Inscribed Quantity: ______
(I1) Niche Cover, Marble, Inscribed Quantity: ______
(J1) Thin Flat Marker, Granite, Inscribed Quantity: ______
(L1) Small Flat Marker, Granite, Inscribed Quantity: ______
(W1) Headstone, Upright, Granite, Inscribed Quantity: ______
(U1) Headstone, Upright, Marble, Inscribed Quantity: ______
(V1) Headstone, Upright, Marble, Granite, Inscribed 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 .