Attachment 2 - EHS Acquisition Review Form - Safety Shoe Contract BPA - Work Wear.pdf

Version 6/2/2023

BUREAU OF ENGRAVING AND PRINTING

ENVIRONMENTAL HEALTH & SAFETY (EHS)

ACQUISITION REVIEW FORM

Instructions:

This form is required for all requisitions above $3,000.00 and must be submitted with the requisition.

This form is to be completed by the Requiring Activity / Contracting Officer Representative (COR) and submitted to the respective currency facility Office of Environmental and Health Safety (OEHS) representative (see list below) with a copy of an SOW/PWS/SOO and applicable Safety Data Sheets (SDSs).

Every action above $3,000.00 shall be submitted to the OEHS for review as part of the acquisition planning package. As mandated by the Affirmative Action Plan (PM No. 2014-03), the OEHS must conduct a pre-award review of the action to ensure correction of any issues and compliance with applicable health and safety regulations.

Once OEHS review has been completed, the Requiring Activity/ COR is to provide this completed and approved form to the Requisitioner, who is responsible for generating the requisition within CLM. As part of the submission process, the Requisitioner is to scan and upload this document into CLM and submit it with the requisition.

The OEHS reserves the right to request a secondary review at the Solicitation stage, to ensure that appropriate health and safety terms have been incorporated prior to a solicitation prior to its publication. It shall be the responsibility of the OEHS representative to determine whether the requirement contains conditions which will necessitate a Solicitation review. If a Solicitation review is necessary, the designated Contract Specialist/Contracting Officer will submit the solicitation to the OEHS prior to publicizing it.

BUREAU OF ENGRAVING AND PRINTING

ENVIRONMENTAL HEALTH & SAFETY (EHS)

ACQUISITION REVIEW FORM

BEP’s ECF EHS Representatives:

Prime: Ricardo Lopez-Merced, 202-874-4358, ricardo.lopez-merced@bep.gov Secondary: Roberto Naranjo, 202-874-2406, roberto.naranjo@bep.gov

BEP’s WCF EHS Representatives:

Prime: Larry Boyd, 817-231-4263, larry.boyd@bep.gov Secondary: Virginia Baldwin, 817-847-3715, virginia.baldwin@bep.gov

To Be Completed by the Requiring Activity/ Contracting Officer Representative

☒ New Acquisition/Delivery Order/Task Order (Complete sections below)

☐ Contract Modification (Complete sections below)

Project Title: Safety Shoe Contract BPA Administrative Change? ☐ Yes ☐ No

Contract/BPA/IDV No.: Contract/BPA/IDV No.:

Requisition Number (if known): Contract Total Dollar Value

(inclusive of all options): $

Independent Government Cost Estimate: $250,000 Current Modification Value: $

To Be Completed by the EHS Representative

Should the requirements document (e.g. SOW, PWS, SOO) be edited to include EHS data? ☐ Yes ☒ No

Will a solicitation EHS review be required? ☐ Yes ☒ No

EHS Pre-Solicitation Review and Recommendations:

Environmental: Concur. As written, the included documentation does not raise any environmental concerns.

Safety: There are no projected safety impacts.

EHS Representative Pre-Solicitation Approval: ☐ Approved As Submitted ☒ Approved with Comments

Name: Larry Boyd, Manager, SOH Branch Signature: Date: 5/6/2024 To Be Completed by the Contracting Officer I have reviewed and acknowledged the pre-solicitation comments or recommendations made by the EHS Representative.

Name: Signature: Date:

State if continuation page is used mailto:ricardo.lpez-merced@bep.gov mailto:roberto.naranjo@bep.gov mailto:larry.boyd@bep.gov mailto:virginia.baldwin@bep.gov

State if continuation page is used

EHS Representative Comments Continuation Page EHS Solicitation Review and Recommendations:

EHS Recommendations Continuation (state if pre-solicitation or solicitation):

EHS Representative Solicitation Approval: ☐ Approved As Submitted ☐ Approved with Comments

Name: Signature: Date:

To Be Completed by the Contracting Officer I have reviewed and acknowledged the solicitation comments or recommendations made by the EHS Representative.

Name: Signature: Date: