Green Procurement Determination Form.pdf

Green Products Determination Form (GPDF) Peterson Air Force Base

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

If applicable, insert Solicitation/Contract/Project No._______________________________ Contact 21CES Environmental or 21 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.

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

Inks

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 non-green product).

GPDF (Continued)

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

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)

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 and Class II 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.

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 CE Environmental 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.

This GPP Element is not applicable to this purchase.

Cadmium Mercury Lead ______ Naphthalene Polychlorinated Biphenyls (PCBs)

SIGNATURES:

Project Manager: Signature, Office Symbol, Date Concurrence by Contracting: Signature, Office Symbol, Date

This GPP Element is not applicable to this purchase.