Atch_3_Recovered_Materials.pdf

UNCLASSIFIED

RECOVERED MATERIALS DETERMINAnON FORM

INSTRUCnONS

This form Is to be completed by the requiring actMty when EPA-designated items af8 applicable to the requilement. For questions on whether the product counts as ·EPA-designated" or what the required teeyCied content is, refer to product description8 on EPA's website at WWW·'M sor/qlcr)Jipduc1s. This form is not requited for construction item pui'Chases less than $2,000, or for other pun:hases less than $2,500. The completad form becomes part of the contracting office contract file.

PROCUREMENT TinE: REPAIR HIGH VOLTAGE TRANSFORMERS

PROCUREMENT REQUEST NO . .:I':D~BE~H'::::I1~3-~1~7~35~----------

PART 1: RECOVERED MATERIALS DETERMINATION

Part 1 shall be completed by the specifying authority when requesting a procurement action.

IPA-DESIGNATEQ ITEMS

(Place a check mark next to each product that applies to this procurement) Conltructlon Products: Park & Recrudon Producfa:

B Building insulation D Park and recreational Polyester carpet furniture

0 Carpet Cushion 0 Playground equ~t cement & conaete containing: D Playground surfaces i8l Coal fly ash 0 Running tracks 181 Ground gi'Wiulated D Plastic fencing (snow or blast furnace stag erosion control, sefetybarriers) 0 Cenospheres Non-paper Otftce Products:

0 Silica fume D Binders (paper, solid D Floor tiles {rubber & R!!latic or plastic covered) e!_astic) D Plastic clipboan:fs 0 Flowable fill 0 Plastic file folders 0 Latex paint 0 Plastic clip portfolios 0 Laminated paperboard 0 Plastic presentation 0 Modular threshold ramps folders

B Nonpresaure pipe o0 Office furniture Patio blocks Office recycling containers

0 Railroad grade 0 Office waste rec:eptaclea crossingal8urfa 0 Plastic desktop 0 Roofing materials accessories 0 Shower & restroom 0 Plastic envelopes dividerslpartitions 0 Plas1ic trash bags 0 Structural fiberboard 0 Printer ribbons Landscaping Product.: D Toner cartridges 0 Compost from yard Paper & Paper Products:

trimmings or food waste 0 Commercial/industrial 0 Garden and soaker hoses sanitary tissue products 0 Hydraulic mulch B Miscellaneous papers 0 Lawn and garden edging Newsprint IJ Plastic lumber landscaping D Paperboard and timbers and posts packaging

0 Printing and writing papers 0 Traylinei'S

Vehicular Products:

0 Engine coolants 0 Rebuilt vehicular parts IJ Re-refinecllubricating oils 0 Retread tires

Transportation Products

Channellzers Delineators Flexible delineators Parking stops Traffic barricades Traffic cones

Mlacdaneoua Products:

0 Awards and plaques 0 Blkeracks 0 Blasting grit 0 Industrial drums IJ Mats 0 Pallets 0 Signage

B Stra=-

UNCLASSIFIED

GREEN PROCUREMENT FORMS

PROCUREMENTTITLE: REPAIR HIGH VOLTAGE TRANSFORMERS

7.1 PROCUREMENT REQUEST NO .. ...:D:.:B:.~E::.H=-1!.ll:3-;....:1..:.,;73=c5~---------

PART.1: RECOVERED MATERIALS DETERMI:NATION (CONT'D)

FAR 11.002(d) requires the establishment of statements of work and specification requirements for the procurement of products contairing recovered materials and environmentally preferable and energy efllcient products and seMce8.

If no EPA designated items were checked on page 1, than check box A:

0 A. I hereby certify that no EPA designated guideline items are inofuded in this procurement action

If any EPA designated items 81'8 checked on P8fJ8 1, than merle box 8 or C:

181 B. I hereby certify that the EPA recycled content requirements have been specified for all of the designated guideHne Items In this procurement action

OR

D C. I hereby certify that the EPA recycled con•t requirements have been specified for all but the following designated guideline Items for which compliance with EPA standards Is not attainable.

If Box C Is checksd, list each du/gntJted Item and the cortNpOnding }U8#iflcstlon number from the list below for each exemption being cl#llmed. Attach the supporting documentation for each waiver

The exemption being claimed for this purchase is:

1. The product is not available competitively (from two or more sources) within a reasonable time frame;

2. The product is only available at an urnaaonable price (blsed on a life..cycle cost analysis);

3. The product does not meet appropriate performance standards (In accordance with National

Institute of Standards and Technology (NIST) guidelines.)

1. _______________________________________________ ___

2----------------------------------------------------------------------------------------------------- 3.

4·-----------------~--~~~-----~~~---------------~-----s.rn De:ecifylng Agent Signature

C-3

UNCLASSIFIED

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Date

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