Attachment__3_-_Green_Procurement_Form.pdf

Green Producb Determination Form (GPDF) Joint Base Charleston

Instructions: This form is to be completed by the requiring activiry to comply with the Joint Base Charleston 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.: _DKFX I I'1059 Work Order No.:

Contact 628 CES/CEV or 628 CONS for further information on GPP.

Materials (i.e., recycled-content) and/or Biobased producb are listed below. Place a check nextto all producb that to be purchased or insert an exemption number (e.g., "E7") from the hottom of the page. lf these GPP Elements are not to this indicate this below and proceed to back of form.

These GPP Elements are not applicable to this purchase.

Construction Products Building insulation products

Polyester Carpet

Cement and concrete containing: coal fly ash, ground granulatedl Newsprint blast furnace slag, cenospheres, or silica flume Consolidated and reprocessed latex paint and coatings

Floor tiles Laminated paperboard

Patio blocks Shower and restroom dividers/partitions Structural fiberboard Carpet cushion

Flowable fiIl(backfill) Railroad grade crossings/surfaces

Modular threshold ramps

Nonpressure pipe

Roofing materials

Roof coatings

Blasting grit Adhesives

Landscaping timbers and posts (plastic lumber) Non-Psper Office Products Binders (paper, solid plastic, or plastic covered)

Office recycling containers

Office waste receptacles

Office furniture Plastic desktop accessories

Plastic envelopes

Plastic trash bags

Printer ribbons Toner cartridges

Plastic clipboards Plastic clip portfolios Plastic file folders Plastic presentation folders nks

Landscaping Products Garden and soaker hoses

Hydraulic mulch Lawn and garden edging Compost (e.g., food, yard trimmings, livestock or crop residues) | Fuels and fuel additives

Paper and Paoer Products

Commercial/industrial sanitary tissue products

Miscellaneous papers (tray liners)

Paperboard and packaging products Printing and writing papers

Park and Recreation Products Plastic fencing (snow or erosion control, safety barriers) Playground surfaces

Running tracks

Park benches and picnic tables Playground equipment Bike racks

Transp oftation Pro ducts

Channelizers

Delineators

Flexibte delineators

Parking stops

Traffic barricades

Traffic cones

Vehicular Products Lubricants and functional fluids Engine Coolants

Re-refi ned lubricatins oils

Retread tires Rebuilt vehicular parts

Mobile equipment hydraulic fluids Diesel fuel additives Miscellaneous Products Penetrating lubricants Pallets

Sorbents

Awards and plaques

Industrial drums

Mats Signage

Strapping

Plastics - monomers and polymers Solvents and cleaners

Other (insert product ExEMPT|oNS:TheAirForcerequirespurchaseofrecyc|ed-contentorbiobasedproductsmeetingEPAor 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 green product).

GPDF (Gontinued) and Water-efficient eligible producE being procured are (check all that apply)

This GPP Element is not applicable to this purchase.

HVAC systems and components Commercial appliances

Residential appliances

Pumps

Motors

Transformers Lighting products

Computers and ofhce equipment (e.g., fax, copier, printer, etc.)

Renewable energy or renewable energy certificates Alternative (green) power llater (FEMP/AFCESA) Irrigation Toilets and urinals Faucets and showerheaos

Boiler and steam systems

Single-pass cooling equipment

Coolins tower Other (insert product

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 Advanced technology vehiclelhybrid

Biodiesel fuel Ethanol fuel Hydrogen fuel Natural gas fuel

Depleting Subsances (ODS) Element (check all that : Air Force purchasers must maximize the use of safe alternatives to ODSs, phase-out the procurement of Class I ODS products, ize the Defense Logistics Agency (DLA) ODS Reserve to reclaim and recycle Class I ODSs for mission-critical uses, and work phasing-out use of all ODS products.

les of products that include ODSs are refrigeration and air conditioning systems and components, foam insulation, cleaning 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 chemicnl below for which an alternative was purchased/

: Air Force purchasers must look for alternatives to the five priority chemicals (or products containing these chemicals) listed Contact your Pollution Prevention Program Manager within 628 CES/CEV for non-hazardous alternatives for these chemicals or mples of products that include these chemicals are batteries; some pigments, metal coatings, and plastics; solder; thermostats, lculators, thermometers, barometers and other small appliances; light fixtures and lamps; electrical switches, cameras, and cathode household cleaners; mothballs and moth repel and toilet deodorant blocks.

This GPP Element is not applicable to this purchase.

Cadmium Lead

Polychlorinated Biphenyls (PCBs)

SIGNATURES:

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