Attachment E - Appendix C - Completion of Inscription Services.pdf
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This document is a completion certification form for on-site inscription services related to government-furnished headstones, markers, and niche covers, likely for the Department of Veterans Affairs (VA).
The form serves as a dual certification document requiring signatures from both cemetery personnel and VA contractor representatives. Cemetery personnel must certify that inscriptions have been completed according to contract specifications and indicate quantities of completed items across ten product categories: Memorial Wall Markers in marble or granite, standard markers in marble, niche covers in granite or marble, thin flat markers in granite, small flat markers in granite, and upright headstones in granite, marble, or combined marble-granite. The form includes a section for documenting rejected items with type and quantity specifications. The VA contractor must then verify receipt of all specified headstones, markers, and niche covers and confirm quantity verification. Both certifying parties must provide printed names, signatures, and dates. This is a template form that does not address specific contract award details, pricing, or response dates.
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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 .