Attachment E - Appendix C - Completion of Inscription Services.pdf
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- Solicitation number
- 36C78626Q0057
About this file
This is an appendix template for completion of inscription services under VA contract 36C78626Q0057 related to on-site inscription services at cemeteries. The form serves as a certification document for cemetery personnel and VA contractors to document the completion and receipt of inscribed government-furnished headstones, markers, and niche covers.
The form requires cemetery personnel to certify that inscriptions have been completed according to contract specifications and to identify the quantity of completed items by type, including: Memorial Wall Markers in Marble (A1) or Granite (C1); Niche Covers in Granite (H1) or Marble (I1); Headstones Upright in Granite (W1), Marble (U1), or Marble/Granite combination (V1); and Niche Covers in Granite (W1). The form includes sections for documenting rejected items by type and quantity. A VA Contractor must then certify receipt of the specified items and verification of quantities. Both cemetery personnel and the VA Contractor must provide printed names, signatures, and dates on their respective certification sections.
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Text version
Attachment E – On-Site Inscription Services – 36C78626Q0057
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: ______
(H1) Niche Cover, Granite, Inscribed Quantity: ______
(I1) Niche Cover, Marble, Inscribed Quantity: ______
(W1) Headstone, Upright, Granite, Inscribed Quantity: ______
(U1) Headstone, Upright, Marble, Inscribed Quantity: ______
(V1) Headstone, Upright, Marble, Granite, Inscribed Quantity: ______
(W1) Niche Cover, 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 .