Green Procurement.pdf

Recovered Materials Determination Form Instructions

This form is to be completed by the procurement originator when EPA-designated items included in the Affirmative Procurement Program for Recovered Materials are being procured from outside vendors. For questions on whether the product counts as “EPA designated” or what the required recycled content is, refer to product descriptions on EPA’s website at http://www.epa.gov/cpg. This form is not required for items requisitioned from established Federal supply sources.

1. The procurement originator lists which item(s) apply to the procurement request, the required recycled content, the actual recycled content, and signs and dates the appropriate Certification on the back of this form.

2. If an exemption is being claimed, the procurement originator’s unit commander also signs the

Certification on the back of this form.

3. The completed form becomes part of the contracting office contract file.

Contract:

The EPA-designated items being procured are:

Construction Products Nonpaper Office Products

Building Insulation Binders (paper, solid plastic or plastic covered)

Polyester Carpeting Plastic presentation folders

Carpet Backing Plastic file folders

Carpet Cushion Plastic clip portfolios

Cement & concrete containing: Plastic clipboards

Coal fly ash, or Office recycling containers

Ground granulated blast Office waste receptacles furnace slag Plastic desktop accessories

Flowable fill Plastic envelopes

Latex paint Plastic trash bags

Floor tiles Printer ribbons

Laminated paperboard Toner cartridges

Patio blocks Paper and Paper Products

Shower & restroom dividers Newsprint

Structural fiberboard Commercial/industrial sanitary tissue products

Railroad grade crossings/surfaces Printing and writing papers

Landscaping Products Paperboard and packaging

Garden & soaker hoses Tray liners

Lawn & garden edging Bristols (File folders, cards, tags, tickets, etc.)

Landscaping timbers & posts (plastic lumber) Miscellaneous Products

Hydraulic mulch Awards and plaques

Compost from yard trimmings or food waste Signage

Vehicular Products Strapping and stretch wrap

Engine coolants Pallets

Re-refined lubricating oils Mats

Retread tires Industrial drums

Park and Recreation Products Sorbents

Plastic fencing (erosion control safety barrier) Transportation Products

Playground surfaces Parking stops

Park and recreation furniture Traffic cones

Running tracks Traffic barricades

Playground equipment Channelizers

Delineators/Flexible delineators http://www.epa.gov/cpg

CERTIFICATION

Contract:

Complete Part A or Part B as appropriate:

A. To the best of my knowledge the Statement of Work/Specifications for the requisition of all materials listed on this form complies with EPA standards for recycled/recovered materials content.

Procurement Originator’s Signature Date

B. The following item does not comply with EPA standards for recycled/recovered materials

(please complete a separate justification for each noncompliant item purchased as part of this procurement action):

The exemption being claimed for this purchase is:

The product does not meet appropriate performance standards

The product is not available within a reasonable time frame

The product is not available competitively (from two or more sources)

The product is only available at an unreasonable price (it costs more than a comparable non-recycled-content product). The recycled-content product costs $ per and the non-recycled-content product costs $ per .

Procurement Originator Date

Commander Date

1229869376C Typewritten Text DKFX 1135561 Repair Air Base Pool