Attachment E - Appendix C - Completion of Inscription Services.pdf
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- Solicitation number
- 36C78626Q0122
About this file
This is a completion certification form for on-site inscription services on government-furnished memorial items used in the Veterans Affairs (VA) cemetery program.
The form serves as a dual certification document requiring sign-off from both cemetery personnel and VA contractors. Cemetery personnel must certify that inscriptions have been completed per contract specifications and document quantities of completed items across ten product categories: Memorial Wall Markers in marble and granite, Markers in marble, Niche Covers in granite and marble, Thin Flat Markers in granite, Small Flat Markers in granite, and Headstones in various configurations (Upright Granite, Upright Marble, and Upright Marble/Granite combinations). The form includes a section for listing rejected items by type and quantity. The VA contractor must then verify receipt of the specified headstones, markers, or niche covers and confirm that item quantities have been verified. Both parties must provide printed names, signatures, and dates to complete the certification 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 .