Atch_4_-_GPP_Form.doc.pdf

RECOVERED MATERIALS DETERMINATION FORM

INSTRUCTIONS

This form is to be completed by the requiring activity when EPA-designated items are applicable to the requirement. 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 www.epa.gov/cpg/products. This form is not required for construction item purchases less than $2,000, or for other purchases less than $2,500. The completed form becomes part of the contracting office contract file.

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

If any EPA designated items are checked on page 1, than mark box B or C:

If Box C 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.

Designated Item Justification #

WALLACE.BRIAN.K.1222107055 Digitally signed by WALLACE.BRIAN.K.1222107055 Date: 2018.03.12 16:58:48 -04'00'

WALLACE.BRIAN.K.1222107

Digitally signed by

WALLACE.BRIAN.K.1222107055

Date: 2018.03.12 17:00:34 -04'00'

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.

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.

Designated Item Justification #