Attachment E - Appendix C - Completion of Inscription Services.pdf
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- Solicitation number
- 36C78626Q0065
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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, issued by the Department of Veterans Affairs (VA).
The form serves as an attestation by cemetery personnel that inscriptions have been completed according to contract specifications. It requires certification from both cemetery personnel and VA contractors, with signature lines and date fields for both parties. The form includes checkboxes and quantity fields for ten different product types: Memorial Wall Marker in Marble or Granite; Marker in Marble; Niche Covers in Granite or Marble; Thin Flat Marker in Granite; Small Flat Marker in Granite; and Headstone Upright options in Granite, Marble, or combined Marble-Granite. The form also includes a section for documenting any rejected items with type and quantity details. The VA contractor must verify receipt of the items and confirm that quantities have been verified before signing. This document is a contractual attestation template rather than a solicitation or statement of work defining service requirements.
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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 .