Attachment_5,_Green_Procurement_Waiver_Form.pdf

WAIVER GREEN PROCUREMENT FORM

(Documentation of Non Purchases)

This form is to be utilized by the contractor to record non-purchases of Green Procurement Products Listed on the EPA’s Web Site www.epa.gov/cpg/products.htm

ITEM:______________________________________________

I have determined that the following Affirmative Procurement Product was considered for purchase but will not be purchased for the following reasons:

Item is not available within a reasonable period of time.

Date Needed: _________________ Date Item would be available: _______________

Item fails to meet a performance standard in the specifications.

Specifically, Item Cost More than the Green Procurement Item.

Price of Green Procurement Item ________________________________________

Price of Non-Green Procurement Item ____________________________________

Contractor Name Contractor Signature Date

COR/Inspector Name COR/Inspector Signature Date

Contracting Officer Name Contracting Officer Signature Date

Attachment 5 FA465918R0005