Attachment 9 -Green Procurement Form.pdf

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Green Products Determination Form (GPDF) Charleston Air Force Base

Instructions: This form is to be completed by the requiring activity to comply with the Charleston AFB Green Procurement Program (GPP). The completed form becomes part of the contract file and/or the purchasing file to document GPP compliance.

Solicitation/Contract/Project No.: JB CHS Facility Enhancement & Maintenance Indefinite Quantity Indefinite Delivery (IDIQ) Contract – FY21

Work Order No._____N/A_________________ Contact 628 CES/CEA or 628 CONS for further information on GPP.

Recovered Materials (i.e., recycled-content) and/or Biobased products are listed below. Place a check next to all products that are to be purchased or insert an exemption number (e.g., “E1”) from the bottom of the page. If these GPP Elements are not applicable to this procurement, indicate this below and proceed to back of form.

X These GPP Elements are not applicable to this purchase.

Construction Products Paper and Paper Products Building insulation products Commercial/industrial sanitary tissue products Polyester Carpet Miscellaneous papers (tray liners)

Cement and concrete containing: coal fly ash, ground granulated blast furnace slag, cenospheres, or silica flume

Newsprint Paperboard and packaging products

Consolidated and reprocessed latex paint and coatings Printing and writing papers Floor tiles Park and Recreation Products Laminated paperboard Plastic fencing (snow or erosion control, safety barriers) Patio blocks Playground surfaces Shower and restroom dividers/partitions Running tracks Structural fiberboard Park benches and picnic tables Carpet cushion Playground equipment Flowable fill (backfill) Bike racks Railroad grade crossings/surfaces Transportation Products Modular threshold ramps Channelizers Nonpressure pipe Delineators Roofing materials Flexible delineators Roof coatings Parking stops Blasting grit Traffic barricades Adhesives Traffic cones Landscaping Products Vehicular Products Garden and soaker hoses Lubricants and functional fluids Hydraulic mulch Engine Coolants Lawn and garden edging Re-refined lubricating oils Compost (e.g., food, yard trimmings, livestock or crop residues) Fuels and fuel additives Landscaping timbers and posts (plastic lumber) Retread tires Non-Paper Office Products Rebuilt vehicular parts Binders (paper, solid plastic, or plastic covered) Mobile equipment hydraulic fluids Office recycling containers Diesel fuel additives Office waste receptacles Miscellaneous Products Office furniture Penetrating lubricants Plastic desktop accessories Pallets Plastic envelopes Sorbents Plastic trash bags Awards and plaques Printer ribbons Industrial drums Toner cartridges Mats Plastic clipboards Signage Plastic clip portfolios Strapping Plastic file folders Plastics – monomers and polymers Plastic presentation folders Solvents and cleaners ______ Inks Other (insert product____________________________) EXEMPTIONS: The Air Force requires purchase of recycled-content or biobased products meeting EPA or USDA recommended levels unless one of the following four exemptions apply:

E1. The product does not meet appropriate performance standards.

E2. The product is not available within a reasonable time frame.

E3. The product is not available competitively (from two or more sources).

E4. The product is only available at an unreasonable price (compared with a comparable green product).

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GPDF (Continued)

Energy- and Water-efficient eligible products being procured are (check all that apply)

X This GPP Element is not applicable to this purchase.

Energy (FEMP/Energy Star ) Water (FEMP/AFCESA) HVAC systems and components Irrigation Commercial appliances Toilets and urinals Residential appliances Faucets and showerheads Pumps Boiler and steam systems Motors Single-pass cooling equipment Transformers Cooling tower Lighting products ______ Other (insert product____________________________) Computers and office equipment (e.g., fax, copier, printer, etc.)

Renewable energy or renewable energy certificates Alternative (green) power ______ Other (describe_________________________________)

Alternative Fuels and Fuel Efficiency Products being procured (or leased) are (check all that apply)

X This GPP Element is not applicable to this purchase.

Fuel-efficient vehicle Biodiesel fuel Advanced technology vehicle/hybrid Ethanol fuel ______ Other (describe_________________________________) Hydrogen fuel Natural gas fuel ______ Propane fuel

Non-Ozone Depleting Substances (ODS) Element (check all that apply) NOTE: Air Force purchasers must maximize the use of safe alternatives to ODSs, phase-out the procurement of Class I ODS products, utilize the Defense Logistics Agency (DLA) ODS Reserve to reclaim and recycle Class I ODSs for mission-critical uses, and work towards phasing-out use of all ODS products.

Examples of products that include ODSs are refrigeration and air conditioning systems and components, foam insulation, cleaning solvents, fire suppressants, aerosol solvents and propellants, sterilants, adhesives, coatings, and inks.

X This GPP Element is not applicable to this purchase.

ODS product purchased from DLA ODS Reserve ______ Other (describe_________________________________) Class I or II ODS alternative being purchased (list below) --alternative product being procured______________________

Priority Chemicals Element (check the EPA priority chemical below for which an alternative was purchased) NOTE: Air Force purchasers must look for alternatives to the five priority chemicals (or products containing these chemicals) listed below. Contact your Pollution Prevention Program Manager within 437 CES/CEV for non-hazardous alternatives for these chemicals or products.

Examples of products that include these chemicals are batteries; some pigments, metal coatings, and plastics; solder; thermostats, calculators, thermometers, barometers and other small appliances; light fixtures and lamps; electrical switches, cameras, and cathode tubes; household cleaners; mothballs and moth repellants, and toilet deodorant blocks.

X This GPP Element is not applicable to this purchase.

Cadmium Mercury Lead ______ Naphthalene Polychlorinated Biphenyls (PCBs)

SIGNATURES:

Requiring Activity: Signature, Office Symbol, Date Concurrence by Contracting: Signature, Office Symbol, Date

HODSON.CYNTHIA.A.1

073026446

Digitally signed by

HODSON.CYNTHIA.A.1073026446

Date: 2020.10.27 13:53:31 -04'00'

MESKO.MICHAEL.P.13

84739152

Digitally signed by

MESKO.MICHAEL.P.1384739152

Date: 2020.11.04 13:00:10 -05'00'