Attachment E - Appendix C - Completion of Inscription Services.pdf
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- Solicitation number
- 36C78626Q0122
About this file
This is a completion and certification form for on-site inscription services provided under a Veterans Affairs (VA) contract for government-furnished headstones, markers, and niche covers.
The form serves as a dual certification document requiring signatures from both cemetery personnel and a VA contractor. Cemetery personnel must certify that inscriptions have been completed per contract specifications and document the quantities of completed items across ten product categories: Memorial Wall Markers in marble and granite, standard markers in marble, niche covers in granite and marble, thin flat markers in granite, small flat markers in granite, and upright headstones in granite, marble, or combination marble-granite. The form includes space to record reject items by type and quantity. The VA contractor then certifies receipt of the headstones, markers, or niche covers and verifies the quantities of items delivered. Both certifications require printed names, signatures, and dates. This is a template appendix rather than a solicitation document containing requirements, pricing terms, or award information.
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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 .