5 JLSS24-9991A Recovered Materials Determination Form.pdf

Air Force Guide to Green Purchasing, January 2005 Page C-1

Recovered Materials Determination Form Instructions

This form is to be completed by the procurement originator when EPA-designated items included in the Green Procurement Program for Recovered Materials are being procured from outside vendors. For questions on whether the product counts as “EPA-designated” or what the required recycled content is, refer to product descriptions on EPA’s website at www.epa.gov/cpg/products. The completed form becomes part of the contracting office contract file.

Procurement Request / Project No.

JLSS 24-9991A, Maintain Base Roads & Pavements

The EPA-designated items being procured are:

___ Building insulation

Polyester carpet

___ Binders (paper, solid plastic or plastic covered)

___ Playground surfaces

___ Park and recreational furniture

Cement & concrete containing:

Coal fly ash Ground granulated blast furnace slag ___ Cenospheres ___ Silica fume

___ Plastic presentation folders

___ Plastic file folders

___ Plastic clip portfolios

___ Plastic clipboards

___ Running tracks

___ Playground equipment

___ Traffic barricades

___ Traffic cones

___ Parking stops

Flowable fill

Latex paint

Floor tiles

___ Laminated paperboard

___ Office furniture

___ Office recycling containers

___ Office waste receptacles

___ Plastic desktop accessories

Plastic fencing (snow or erosion control, safety barriers)

___ Channelizers

___ Patio blocks ___ Plastic envelopes ___ Delineators

Shower & restroom dividers/partitions

___ Plastic trash bags

___ Flexible delineators

___ Rebuilt vehicular parts

___ Structural fiberboard ___ Printer ribbons ___ Engine coolants

___ Railroad grade crossing surfaces

___ Toner cartridges

___ Newsprint ___ Re-refined lubricating oils

___ Retread tires

___ Garden and soaker hoses

___ Lawn and garden edging

___ Commercial/industrial sanitary tissue products

___ Sorbents

___ Awards and plaques

___ Landscaping timbers and posts (plastic lumber)

___ Printing and writing papers

___ Paperboard and packaging ___ Mats

___ Signage

___ Hydraulic mulch ___ Tray liners ___ Strapping

___ Compost from yard trimmings or food waste

___ Industrial drums ___ Pallets

___ Modular threshold ramps

___ Non-pressure pipe

___ Bike racks

___ Roofing materials

___ Blasting grit

Air Force Guide to Green Purchasing, January 2005 Page C-2

Recovered Materials Procurement Determination

__x_ EPA recycled-content requirements have been met for this procurement action.

**** OR *****

___ The following EPA designated guideline item is included in the specifications for project number , however, compliance with EPA standards is not attainable.

Item:

I have determined that the EPA guidelines were considered and determined inapplicable, based on the following:

_____ Item is not available within a reasonable period of time.

Need date: _____________________ Date available:

Item fails to meet a performance standard in the specifications.

Describe the standard and why it is needed: _____

Describe how the guideline item fails to meet the standard: __________________

_____ Item is not available from 2 or more sources.

Market research was performed by calling ____(insert number) vendors, but only ________________________________ (enter name) was able to supply the item.

_____ Item was only available at an unreasonable price (i.e., recycled item is more expensive).

Price of recycled item: ___________________

Price of non-recycled item: ________________

This determination is made in accordance with FAR 23.405(c).

Technical OPR - Signature and Office Symbol Date

Concurrence - Contracting Officer Date

Recovered Materials Procurement Determination