Attch_6_FGJ_Lines_GPP_forms.pdf

UNCLASSIFIED

GREEN PROCUREMENT FORMS

C-4

UNCLASSIFIED

PROCUREMENT TITLE: REPAIR F, G and J Lines Supporting Launch Complexes (LET)

7.2 PROCUREMENT REQUEST NO. DBEH 07-1562

PART 2: RECOVERED MATERIALS CERTIFICATION

Part 2 of this certification is to be completed upon receipt of the purchase goods and services. If EPA designated items were specified in this procurement action, the contractor/supplying agent shall complete Part 2 of this certification upon delivery of the products or services. Attach supporting documentation identifying percentage of recovered material content used in each designated item. NOTE: A designated item is specified if no exemptions were prepared and identified in Part 1.C of this form during the development of this procurement action.

Check the appropriate box:

A. EPA recycled content requirements have been met for all designated items specified in this procurement action.

OR

B. EPA recycled content requirements have been met for all but the following EPA designated guideline item(s) for which compliance with EPA standards was not attainable.

If Box B is checked, list each designated item and the corresponding justification number from the list below for each exemption being claimed. 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 unreasonable price (based 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.)

Designated Item Justification #

1.

2.

3.

4.

5.

Contractor/Supplying Agent Signature Date

Requiring Organization’s Technical Representative Signature Date