Attachment_4_-_FA4418-17-R-0020_-_Green_Procurement_Form.pdf

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._______________________________

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.

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

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).

DKGV 11-2127 CES Renovation, WS Bldg. 909 x x

1179187112C Typewritten Text Solicitation FA4418-17-R-0020

Energy- and Water-efficient eligible 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 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 437 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.

This GPP Element is not applicable to this purchase.

Cadmium Mercury

Lead _____ Naphthalene

Polychlorinated Biphenyls (PCBs) x x

The mechanical system has been designed using R410A Refrigerant. The mechanical design does not include Class I ozone depleting substances.

1179187112C

Solicitation FA4418-17-R-0020

-over-

SIGNATURES:

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

Glick/Boehm & Associates, 2/28/17

1179187112C Typewritten Text Solicitation FA4418-17-R-0020

1177781912C

Scott D. Rogge, 628 CONS/LGCB, 7/14/17