Attachment 4 - Green Procurement Recovered Materials Form.pdf

Recovered Materials Determination Form Instructions

This form is to be completed by the procurement originator when EPA-designated items included in the Affirmative 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 http://www.epa.gov/cpg. This form is not required for items requisitioned from established Federal supply sources.

1. The procurement originator lists which item(s) apply to the procurement request, the required recycled content, the actual recycled content, and signs and dates the appropriate Certification on the back of this form.

2. If an exemption is being claimed, the procurement originator’s unit commander also signs the

Certification on the back of this form.

3. The completed form becomes part of the contracting office contract file.

Contract: DKFX 1091585 Repair Facility Envelope & Roof Flight Simulator - B108

The EPA-designated items being procured are:

Construction Products Nonpaper Office Products

Building Insulation Binders (paper, solid plastic or plastic covered) Polyester Carpeting Plastic presentation folders Carpet Backing Plastic file folders Carpet Cushion Plastic clip portfolios

Cement & concrete containing: Plastic clipboards Coal fly ash, or Office recycling containers Ground granulated blast Office waste receptacles furnace slag Plastic desktop accessories Flowable fill Plastic envelopes Latex paint Plastic trash bags Floor tiles Printer ribbons Laminated paperboard Toner cartridges Patio blocks Paper and Paper Products Shower & restroom dividers Newsprint Structural fiberboard Commercial/industrial sanitary tissue products Railroad grade crossings/surfaces Printing and writing papers

Landscaping Products Paperboard and packaging Garden & soaker hoses Tray liners Lawn & garden edging Bristols (File folders, cards, tags, tickets, etc.)

Landscaping timbers & posts (plastic lumber) Miscellaneous Products Hydraulic mulch Awards and plaques Compost from yard trimmings or food waste Signage

Vehicular Products Strapping and stretch wrap Engine coolants Pallets Re-refined lubricating oils Mats Retread tires Industrial drums

Park and Recreation Products Sorbents Plastic fencing (erosion control safety barrier) Transportation Products Playground surfaces Parking stops Park and recreation furniture Traffic cones Running tracks Traffic barricades Playground equipment Channelizers

Delineators/Flexible delineators http://www.epa.gov/cpg

CERTIFICATION

Contract: DKFX 1091585 Repair Facility Envelope & Roof Flight Simulator - B108

Complete Part A or Part B as appropriate:

A. To the best of my knowledge the Statement of Work/Specifications for the requisition of all materials listed on this form complies with EPA standards for recycled/recovered materials content.

17 Nov 21 Procurement Originator’s Signature Date

B. The following item does not comply with EPA standards for recycled/recovered materials (please complete a separate justification for each noncompliant item purchased as part of this procurement action):

The exemption being claimed for this purchase is:

The product does not meet appropriate performance standards

The product is not available within a reasonable time frame

The product is not available competitively (from two or more sources)

The product is only available at an unreasonable price (it costs more than a comparable non-recycled-content product). The recycled-content product costs $ per and the non-recycled-content product costs $ per .

Procurement Originator Date

Commander Date