Attachment E - Appendix C - Completion of Inscription Services.pdf
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This document is a completion and verification form for on-site inscription services on government-furnished cemetery monuments and markers. The form serves as a certification template used by cemetery personnel and VA contractors to document the completion of inscription work and verify receipt of finished items.
The form requires cemetery personnel to certify that inscriptions have been completed per contract specifications and to identify completed items by type and quantity. Ten categories of inscribed monuments and markers are listed for documentation: Memorial Wall Markers in marble (A1) and granite (C1); Markers in marble (F1); Niche Covers in granite (H1) and marble (I1); Thin Flat Markers in granite (J1); Small Flat Markers in granite (L1); and Headstones in three configurations—Upright Granite (W1), Upright Marble (U1), and Upright Marble/Granite combination (V1). The form includes space to document rejected items with type and quantity details. A VA Contractor must then certify receipt of all specified headstones, markers, and niche covers and verify that quantities have been confirmed, with required signatures and dates from both cemetery personnel and the contractor. This appendix is part of Attachment E addressing on-site inscription services under what appears to be a VA cemetery monument inscription contract.
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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 .