Attachment E - Appendix C - Completion of Inscription Services.pdf
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This document is a completion of inscription services form (Appendix C) for on-site inscription services related to government-furnished headstones, markers, and niche covers, likely administered by the Department of Veterans Affairs (VA).
The form serves as a certification document requiring cemetery personnel to verify that inscriptions have been completed per contract specifications on various types of memorial items. Cemetery personnel must provide their printed name, signature, and date, then indicate quantities of completed inscribed items across ten product categories: Memorial Wall Marker in Marble (A1) or Granite (C1), Marker in Marble (F1), Niche Covers in Granite (H1) or Marble (I1), Thin Flat Marker in Granite (J1), Small Flat Marker in Granite (L1), and Headstones in three configurations—Upright Granite (W1), Upright Marble (U1), or Upright Marble/Granite combination (V1). The form includes a section to document any rejected items by type and quantity. A VA Contractor must then certify receipt of the specified items, verify quantities, provide their printed name, signature, and date. This form functions as a quality assurance and acceptance document within the inscription services contract process.
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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 .