Atch7GPP.doc

UNCLASSIFIED

Green Procurement Waiver Statement for Projects at Patrick AFB

PROCUREMENT TITLE: SXHT 16-1280; Repair Upgrade Perimeter Fence

PROCUREMENT REQUEST NO. FA2521-13-D-0005-18F0043

None of the products that I am specifying for procurement are listed on a mandatory environmental purchasing list, including:

1.

U.S. EPA Comprehensive Procurement Guidelines (formally APP items) published at www.epa.gov/cpg/products.htm.

2.

USDA Biobased product listings published at www.biobased.oce.usda.gov/public/categories.cfm.

3.

Energy Star® product listings published at www.energystar.gov/products.

4.

FEMP Low Standby Power product listings published at http://oahu.lbl.gov/ Therefore, I am not required to include a Recovered Materials Determination Form (RMDF) with this procurement package.

In addition, I have sought to reduce the environmental damages associated with this procurement by considering the specification of environmentally preferable products and services to the extent feasible, consistent with price, performance, availability, and safety considerations. I have considered products with recycled or biobased content as well as other environmentally preferable attributes, such as:

· Reduced packaging

· Durability and reparability

· Reduced toxicity

· Conservation of natural resources

· Water conservation

· Low Volatile Organic Compound (VOC) Content

· Asbestos alternative

Design/Specifying Agent Signature

Date

Requiring Organization’s Technical Representative Signature

RECOVERED MATERIALS DETERMINATION FORM

(Part 1) Design/Procurement

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 $3,000. The completed form becomes part of the contracting office contract file.

PROCUREMENT TITLE: SXHT 16-1280; Repair Upgrade Perimeter Fence

PROCUREMENT REQUEST NO. FA2521-13-D-0005-18F0043

PART 1: RECOVERED MATERIALS DETERMINATION

Part 1 shall be completed by the specifying authority when requesting a procurement action. EPA-DESIGNATED ITEMS (Place a check mark next to each product that applies to this procurement)

Construction Products:

FORMCHECKBOX

Building insulation

FORMCHECKBOX

Polyester carpet

FORMCHECKBOX

Carpet Cushion

Cement & concrete containing:

FORMCHECKBOX

Coal fly ash

FORMCHECKBOX

Ground granulated blast furnace slag

FORMCHECKBOX

Cenospheres

FORMCHECKBOX

Silica fume

FORMCHECKBOX

Floor tiles (rubber & plastic)

FORMCHECKBOX

Flowable fill

FORMCHECKBOX

Latex paint

FORMCHECKBOX

Laminated paperboard

FORMCHECKBOX

Modular threshold ramps

FORMCHECKBOX

Nonpressure pipe

FORMCHECKBOX

Patio blocks

FORMCHECKBOX

Railroad grade crossings/surfaces

FORMCHECKBOX

Roofing materials

FORMCHECKBOX

Shower & restroom dividers/partitions

FORMCHECKBOX

Structural fiberboard Landscaping Products:

FORMCHECKBOX

Compost from yard trimmings or food waste

FORMCHECKBOX

Garden and soaker hoses

FORMCHECKBOX

Hydraulic mulch

FORMCHECKBOX

Lawn and garden edging

Plastic lumber landscaping timbers and posts

Park & Recreation Products:

Park and recreational furniture

FORMCHECKBOX

Playground equipment

FORMCHECKBOX

Playground surfaces

FORMCHECKBOX

Running tracks

FORMCHECKBOX

Plastic fencing (snow or erosion control, safetybarriers)

Non-paper Office Products:

FORMCHECKBOX

Binders (paper, solid plastic or plastic covered)

FORMCHECKBOX

Plastic clipboards

FORMCHECKBOX

Plastic file folders

FORMCHECKBOX

Plastic clip portfolios

FORMCHECKBOX

Plastic presentation folders

FORMCHECKBOX

Office furniture

FORMCHECKBOX

Office recycling containers

FORMCHECKBOX

Office waste receptacles

FORMCHECKBOX

Plastic desktop accessories

FORMCHECKBOX

Plastic envelopes

FORMCHECKBOX

Plastic trash bags

FORMCHECKBOX

Printer ribbons

FORMCHECKBOX

Toner cartridges

Paper & Paper Products:

FORMCHECKBOX

Commercial/industrial sanitary tissue products

FORMCHECKBOX

Miscellaneous papers

FORMCHECKBOX

Newsprint

FORMCHECKBOX

Paperboard and packaging

FORMCHECKBOX

Printing and writing papers

FORMCHECKBOX

Tray liners

Vehicular Products:

FORMCHECKBOX

Engine coolants

FORMCHECKBOX

Rebuilt vehicular parts

FORMCHECKBOX

Re-refined lubricating oils

FORMCHECKBOX

Retread tires

Transportation Products

FORMCHECKBOX

Channelizers

FORMCHECKBOX

Delineators

FORMCHECKBOX

Flexible delineators

FORMCHECKBOX

Parking stops

FORMCHECKBOX

Traffic barricades

FORMCHECKBOX

Traffic cones

Miscellaneous Products:

FORMCHECKBOX

Awards and plaques

FORMCHECKBOX

Bike racks

FORMCHECKBOX

Blasting grit

FORMCHECKBOX

Industrial drums

FORMCHECKBOX

Mats

FORMCHECKBOX

Pallets

FORMCHECKBOX

Signage

FORMCHECKBOX

Sorbents

Strapping

RECOVERED MATERIALS DETERMINATION FORM

(PART 1) Design/Procurement (Cont’d)

PROCUREMENT TITLE: SXHT 16-1280; Repair Upgrade Perimeter Fence

PROCUREMENT REQUEST NO. FA2521-13-D-0005-18F0043

FAR 11.002(c) requires the establishment of statements of work and specification requirements for the procurement of products containing recovered materials and environmentally preferable and energy-efficient products and services.

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

FORMCHECKBOX

A. I hereby certify that no EPA designated guideline items are included in this procurement action If any EPA designated items are checked on page 1, than mark box B or C:

FORMCHECKBOX

B. I hereby certify that the EPA recycled content requirements have been specified for all of the designated guideline items in this procurement action

OR

FORMCHECKBOX

C. I hereby certify that the EPA recycled content 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 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.

RAEIS/ Project Lead

02/09/2018 Design/Specifying Agent Signature

RECOVERED MATERIALS DETERMINATION FORM

(PART 2) Construction PROCUREMENT TITLE: SXHT 16-1280; Repair Upgrade Perimeter Fence

PROCUREMENT REQUEST NO.

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:

FORMCHECKBOX

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

OR

FORMCHECKBOX

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 item listed.

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 #

2.

3.

Contractor/Supplying Agent Signature

RECOVERED MATERIALS DETERMINATION FORM

Waiver Form

PROCUREMENT TITLE: SXHT 16-1280; Repair Upgrade Perimeter Fence

PROCUREMENT REQUEST NO.

The technical authority shall prepare a separate justification for each designated item purchased that does not meet EPA standards as part of this procurement action:

The following item does not comply with EPA standards for recycled/recovered materials:

The exemption being claimed for this purchase is:

FORMCHECKBOX

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

FORMCHECKBOX

The product does not meet appropriate performance standards (in accordance with National Institute of Standards and Technology (NIST) guidelines);

FORMCHECKBOX

The product is only available at an unreasonable price (based on a price analysis that considers life-cycle cost). The recycled-content product costs $ per and the non-recycled-content product costs $ per .

This written justification is made in accordance with 42USC 6962(c)(1):

Design/specifying Agent’s Signature

Contracting Officer’s Signature

Rationale for exemption: (Please provide the rationale upon which this justification was based. Include vendor names, points of contact, life-cycle cost analysis and any other documentation that supports this decision.

Green Procurement Waiver Statement – Instructions

1.

PURPOSE OF STATEMENT. This “Green Procurement Waiver Statement” provides documentation that GPP has been considered for projects that do not require the use of U.S. EPA-designated CPG items, USDA-designated biobased items, Energy Star® listed items, or FEMP Low Standby Power items. A similar memo or email statement can be used in lieu of this statement.

2.

OPR. Civil Engineering and all other organizations procuring items through other avenues than the Government-wide Purchase Card (GPC).

3.

OCR. Contracting, Civil Engineering/Operations, Civil Engineering/Construction, Civil Engineering/SABER, and Civil Engineering/Materiel Acquisition.

4.

APPLICABILITY. This “Green Procurement Waiver Statement” applies to procurement actions (other than GPC purchases) that do not require items that must comply with CPG, biobased, Energy Star®, or FEMP requirements.

5.

INTENT FOR USE.

a.

GPC cardholders should not complete this form and use the “GPC Green Procurement Purchasing Log” instead.

b.

The Environmental Flight will incorporate this “Green Procurement Waiver Statement” into the PAFB Environmental Requirements Specification boilerplate documentation. These specifications will be included in all service and construction contracts, as well as all in‑house work orders greater than $3,000.

c.

For in-house job and work orders (regardless of project cost), contractors and CE Operations shop personnel will be responsible for completing this “Green Procurement Waiver Statement” for all procurement actions if none of the items on the mandatory purchasing lists are required. The OCR organizations listed above will be responsible for checking and verifying the completed GPP Waiver Statement.

d.

If the procurement action includes any CPG, biobased, Energy Star®, or FEMP Low Standby Power items, use the Recovered Materials Determination Form (RMDF) instead.

6.

FILING PROCEDURE. If applicable, a completed “Green Procurement Waiver Statement” will be included in the purchasing or contracting file. Contracting is responsible for ensuring that either a “Green Procurement Waiver Statement” or RMDF is included in contracting files.

DIRECTIONS FOR USE OF THE RECOVERED

MATERIALS DETERMINATION FORM

GPC Green Procurement Purchasing Log – Page 1

Purchaser/Requester completes this form prior to making any purchases and retains a copy in their purchasing records. Copy and attach additional sheets, as needed. Consult the Patrick GPP OPLAN for additional guidance. Submit quarterly a copy of the completed log to Wayne Neville, 45 CES/CEVC. Complete the first line and submit a blank form if no GPP purchases were completed.

Purchase Requester Name, Office Symbol, Phone:

circle the appropriate exemption or reason for non-compliance

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

GPC Green Procurement Purchasing Log – Page 2

circle the appropriate exemption or reason for non-compliance

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

C J/U/G Purchase NA P S T

LEGEND

C = Item was not competitively available

GPP = Green Procurement Program (see GPP Requirements Reference Sheet)

EPP = Environmentally Preferable Purchasing

J/U/G Purchase = Item was purchased under one of the mandatory purchase programs (JWOD, UNICOR), or GSA.

NA = Item is not on the U.S. EPA-designated list P = Item was too expensive (price)

S = Item did not meet technical specifications

T = Item was not available in a timely manner

Y/N = Yes or No

GPC Green Procurement Purchasing Log – Instructions

PURPOSE OF STATEMENT. This “GPC Green Procurement Purchasing Log” (GPC Log) is intended to be used to document credit card holders’ purchases of items that are designated for green procurement under one of the mandatory Federal programs. The GPC Log identifies whether or not the product that was purchased, met GPP requirements and documents the reason for choosing a non-compliant product.

2.

OPR. All GPC cardholders.

3.

OCR. None.

4.

APPLICABILITY. This GPC Log applies to all purchases made by GPC cardholders.

5.

INTENT FOR USE. The GPC holder can maintain a running GPC Log to document each GPC purchase.

6.

FILING PROCEDURE. The GPC Log must be included in the GPC holder purchasing file for auditing purposes.

7.

REPORTING PROCEDURE. A copy of the completed GPC Log must be submitted to Wayne Neville, 45CES/CEVC on the last day of each quarter or four times annually. Complete the first line and submit a blank form if no GPP purchases were completed.

Revision Date: 04 May 2007

UNCLASSIFIED

_1211006792.vsd

Complete top of the Recovered Materials Determination Form (RMDF) Form and check mark all EPA-designated items applicable to this acquisition.�

Complete page 2 of the RMDF Form�

Check mark Box A on Part 1 of the RMDF Form. Provide signatures/dates. �

Were any EPA-designated items checked on page 1of the RMDF Form? �

Yes�

No�

Check mark Box C on Part 1 of the RMDF Form and complete the justification section. Provide signatures/dates. �

Yes�

No�

Were all possible EPA-designated items specified in the procurement action?�

Check mark Box B on Part 1 of the RMDF Form. Provide signatures/dates. �

Complete Part 2 of the RMDF Form�

Were all EPA-designated items specified in the procurement action purchased?�

No�

Yes�

Check mark Box A on Part 2 of the RMDF Form. Provide signatures/dates. �

Check mark Box B on Part 2 of the RMDF Form and complete the justification section. Provide signatures/dates. �

Complete page 2 of Part 2 for each EPA-designated item for which an exemption has been claimed on Part 1 or 2 of the RMDF Form. �

Place all forms in the Contracting Office contract/project file.�