Appendix F - Sustainable Acquisition Exception Form - HJB 225.pdf

HJB Form 225, MAR 2014

SUSTAINABLE ACQUISITION EXCEPTION

Joint Base Lewis-McChord, WA

POINT OF CONTACT AND ORGANIZATION INFORMATION

1. Name 2. Title 3. Telephone

4. Organization 5. E-mail 6. Fax

CONTRACT INFORMATION (if related to a contract action, otherwise leave blank) Contracting Officer, Contracting Officer's Representative, or Project Manager Contact Information

7. Name 8. Organization 9. Phone 10. Email

11. Address

Project/Service Information

12. Project/Service Name 13. Contract Number or Other Identifier

EXCEPTION

14. Requirement Against Which Exception is Claimed (Check all that apply)

15. Reason for Exception (Check all that apply and provide details at section 18)

Recycled/Recovered Materials Price/Cost Biobased Content Life Cycle Cost WaterSense (water efficiency) Performance/Functional Requirements Energy Star/FEMP (energy efficiency) Availability EPEAT Statutory Exemption Low Emitting Materials Rapidly Renewable Materials Sustainble Wood

RESEARCH

16. List All Products/Services Researched and Vendors/Sources Consulted in Making Exception Determination

PRODUCT INFORMATION

17. Non-Compliant Product or Service that Will be Used (Supply or attach product name, national stock number, product code, description and other identifying information, as applicable)

HJB Form 225, MAR 2014

18. Cost (per unit of measure)

JUSTIFICATION*

19. Supply information justifying the use of the exception below AND attach any supporting documentation

* Justification must demonstrate the unsuitability of all available compliant options based on cost, availability, functional requirements, or performance.

Cost comparisons must show that all compliant options are only available at an unreasonable price or have higher life cycle costs than a non-Energy Star/FEMP/WaterSense product.

Life cycle cost determination shall be per 10 CFR 436, subpart A (http://www.gpo.gov/fdsys/) or another method determined to be equivalent by the DoD.

For exceptions based on statutory requirements and/or requirements based on standing orders for the maintenance and operation of U.S. Armed Forces tactical equipment, attach a photocopy of the applicable regulation/military specification.

ORGANIZATIONAL APPROVAL (approving official signature below, if required by your organization --otherwise, leave blank)

Signature Date

Return form and copies of supporting documents to usarmy.jblm.imcom.list.dpw-green-procurement@mail.mil. If related to a contract, submit to appropriate contracting official with the above address in the cc line, or ask that they forward a copy to the JBLM Sustainable Acquisition Program Coordinator (Bldg 1210, 966-6466). Supporting documents can include catalog data, technical data sheets, price listings, life cycle cost calculations, etc.