Green_Procment_Form_-_Attachmnt_4.pdf

Headquarters 628th Airlift Wing Joint Base Charleston, South Carolina 29404

June 2012

CAFB GREEN PROCUREMENT PLAN

APPENDIX C

GREEN PRODUCTS DETERMINATION FORM

Green Products Determination Form

User’s Guide

Purpose of Form: The “Green Products Determination Form” (GPDF) is utilized to clearly document compliance with the Charleston AFB Green Procurement Program (GPP) Plan. This includes compliance with seven elements of the program as follows:

Recovered Materials (formerly referred to as Affirmative Procurement which covers the Comprehensive Procurement Guideline [CPG] requirements for recycled and reclaimed content of products); Biobased Products; Energy and Water Efficient Products;

Alternative Fuels and Fuel Efficiency; Non-Ozone Depleting Substances (ODS); Priority Chemicals; and Environmentally Preferable Products. It is also used to document the use of applicable exemptions taken for the Recovered Materials and Biobased items not selected for procurement.

OPR: 628 CES/CEP and all other purchasers making procurements other than through utilizing the Government-wide Purchase Card (GPC).

OCR: 628 CONS

Applicability: The GPDF applies to all procurement actions (other than GPC purchases) covered by the Charleston AFB GPP. This includes items that are listed in the CPG, Biobased, Energy Star®, FEMP Low Standby Power, Water Efficiency, Non-ODS, Alternative Fuel and Fuel Efficiency, and Priority Chemical programs.

Intent for Use:

a. GPC holders will not complete this form and will use the “GPC Coordination Sheet” instead.

b. Everyone on base who purchases products or services via purchase order, blanket purchase agreement, contract, and so forth (except for GPC purchase) are responsible for completing a GPDF. The OCR organizations listed above will be responsible for verifying that GPDFs are completed for all procurement actions.

Filing Procedure: The completed GPDFs will be included in the purchasing or contracting file. 628 CONS is responsible for ensuring that a GPDF is included in contracting files.

-end-

Green Products Determination Form (GPDF) Charleston Air Force Base

Instructions: This form is to be completed by the requiring activity to comply with the Charleston 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.__DKGV 11-2192____________________ Work Order No._________________________

Contact 628 CES/CEV or 628 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.

X 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 Paperboard and packaging products

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

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 green product).

GPDF (Continued)

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

X 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)

X 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 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.

X 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 628 CES/CEV 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.

X This GPP Element is not applicable to this purchase.

Cadmium Mercury

Lead ______ Naphthalene

Polychlorinated Biphenyls (PCBs)

SIGNATURES:

628 CES/CENMP __________________________________________________

Requiring Activity: Signature, Office Symbol, Date Concurrence by Contracting: Signature, Office Symbol, Date

This GPP Element is not applicable to this purchase.