Attachment E - Appendix C - Completion of Inscription Services.pdf
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- 36C78626Q0061
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This document is a completion of inscription services form (Appendix C) used for on-site inscription services under a Veterans Affairs (VA) contract involving government-furnished headstones, markers, and niche covers.
The form serves as a certification document completed by cemetery personnel to document the completion of inscription work on various types of memorial items. Cemetery personnel must provide their printed name, signature, and date, then indicate quantities of completed and inscribed items across ten product categories: Memorial Wall Markers (Marble or Granite), standard Markers (Marble), Niche Covers (Granite or Marble), Thin Flat Markers (Granite), Small Flat Markers (Granite), and Headstones in Upright configurations (Granite, Marble, or combination Marble-Granite). The form includes a section for documenting rejected items with type and quantity specifications. A VA Contractor representative must then verify receipt of the items and confirm quantity verification through their printed name, signature, and date. This form functions as an inspection and acceptance document within the inscription services workflow, establishing accountability between cemetery personnel performing the work and the contracting entity responsible for oversight.
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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 .