Attachment 10 - HJB FORM 225.pdf
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- Security System Upgrades
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- W911S825BA016
About this file
The document is a Sustainable Acquisition Exception form (HJB Form 225) from Joint Base Lewis-McChord, Washington, dated March 2014. The form is designed to document and justify exceptions to sustainable acquisition requirements for federal procurement. It provides fields for documenting contact information, contract details, and the specific sustainability requirements being exempted, such as recycled materials, biobased content, energy efficiency, and water efficiency standards. The form requires detailed justification for why a non-compliant product or service will be used, including cost comparisons, availability issues, or functional requirement limitations. Supporting documentation must be attached to demonstrate the unsuitability of compliant options, and the completed form should be submitted to the base's Sustainable Acquisition Program Coordinator.
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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.
| 1 Name: |
| 2 Title: |
| 3 Telephone: |
| 4 Organization: |
| 5 Email: |
| 6 Fax: |
| 7 Name: |
| 8 Organization: |
| 9 Phone: |
| 10 Email: |
| 11 Address: |
| 12 ProjectService Name: |
| 13 Contract Number or Other Identifier: |
| 17 Cost per unit of measure: |
| Check Box 4: Off |
| Check Box 5: Off |
| Check Box 3: Off |
| Check Box 1: Off |
| Check Box 2: Off |
| Check Box 6: Off |
| Check Box 7: Off |
| Check Box 8: Off |
| Check Box 9: Off |
| Check Box 10: Off |
| Check Box 11: Off |
| Check Box 12: Off |
| Check Box 13: Off |
| 18 Supply Information: |
| 16 Non Compliant Product or Service: |
| 16 List All Products/Services Researched and Vendors/Sources Consulted: |
| Date (MM/DD/YYYY: |
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