5_-_Cont_Affirm_Procurement_Report.pdf

CONTRACTOR AFFIRMATIVE PROCUREMENT REPORT FORM FOR

ESTIMATION OF RECOVERED MATERIAL CONTENT LEVELS

FOR EPA DESIGNATED ITEMS

(PER EXECUTIVE ORDER 13101)

CONTRACTOR: ______________________________________________

CONTRACT/DO #: ___________________________________________

BLDG # (if applicable): ________________________________________

PROJECT MANAGER: ________________________________________

INSTRUCTIONS

1. Use this form to document estimation of recovered material content levels per FAR provision 52.223-9, “Certification and Estimate of Percentage of Recovered Material for EPA Designated Items.”

2. Complete the table below for those EPA Designated Items used in performance of work under this contract/ delivery order that met or exceeded the minimum materials content levels (see 2 nd column in table below).

Provide the actual recovered material content (if different from 2 nd column) and quantity for these items in the appropriate column, if available.

3. Mark each line with “N/A” for those item/s not used in the performance of this contract/delivery order.

4. Note any exemptions in 5 th column for each item for which a Contractor Waiver Form was previously submitted.

5. Submit to the Contracting Officer at the completion of the contract.

RECYCLED OR RECOVERED

PRODUCT

TOTAL RECOVERED

MATERIALS

CONTENT (RMC)

ACTUAL

RMC (%)

QUANTITY

USED

EXEMPTION

(1,2,3)

Rock Wool Insulation 75%

Fiberglass Insulation 20-25%

Cellulose loose fill/Spray-on Insulation 75%

Perlite Composition Board Insulation 23%

Plastic Rigid Foam Insulation 9%

Plastic Foam In Place Insulation 5%

Plastic Foam, Glass Fiber Reinforced Insulation

6%

Phenolic Rigid Foam Insulation 5%

Structural Fiber Board 80-100%

Laminated Paper Board 100%

Cement/Concrete (FLYASH) See www.epa.gov/cpg

High Fly Ash Flowable Fills 95%

Low Fly Ash Content Flowable Fill 6-14%

Carpet (PET) 25-100%

Bonded polyurethane Carpet Cushion 15-50%

Jute Carpet Cushion 40%

Synthetic fibers Carpet Cushion 100%

Rubber Carpet Cushion 60-90%

Rubber Plastic Patio Blocks 90-100%

Rubber or Plastic Floor Tile 90-100%

Steel Restroom Divider/Partition 15%

Plastic Restroom Divider/Partition 20-100%

Concrete Railroad Crossing 15-20%

Rubber Railroad Crossing 85-95%

Steel Railroad Crossing 25-30%

BOF/100%EAF2

Traffic cones made from PVC, LDPE, crumb Rubber

50-100%

Traffic Barricades (Type I and II only) made from HDPE, LDPE, PET, steel, fiberglass

100%

Attachment 0005 http://www.epa.gov/cpg

TOTAL RECOVERED

MATERIALS

CONTENT (RMC)

ACTUAL

RMC (%)

QUANTITY

USED

EXEMPTION

(1,2,3)

Channelizers, Plastic 25-95%

Channelizers, rubber base 100%

Delineators, plastic 25-90%

Delineators, rubber base 100%

Delineators, steel base 25-50%

Flexible plastic delineators 25-85%

Parking Stops, Plastic or Rubber 100%

Parking Stops, Concrete containing coal fly ash

20-40%

Parking Stops, Concrete containing Ground- Granulated Blast Furnace Slag

25-70%

Playground Surfaces, including rubber or plastic

90-100%

Plastic Fencing for use to control snow, drifting Sand, or as a safety barrier

90-100%

Running Tracks. Including rubber or plastic

90-100%

Plastic Park benches and Picnic Tables

100%

Plastic composite Park benches and Picnic Tables

100%

Aluminum Park benches and Picnic Tables

25%

Concrete Park benches and Picnic Tables

15-40%

Steel Park benches and Picnic Tables 25-30%

BOF/100%EAF

Plastics Playground Equipment 100%

Plastic Composites Playground Equipment

95-100%

Steel Playground Equipment 25-30% BOF/100%

EAF

Aluminum Playground Equipment 25%

Garden hose, rubber or plastic 60-65% post consumer materials

Soaker hose, rubber or plastic 60-70% post consumer materials

Lawn/garden edging, plastic or rubber 30-100%

Paper-based hydraulic mulch 100%

Wood-based hydraulic mulch 100%

Compost Purchase or use compost made from yard trimmings, leaves, grass clippings, and food waste

100%

HDPE lumber timbers and posts 75-100%

Mixed plastics/Sawdust lumber timbers and posts

100%

HDPE/Fiberglass lumber timbers and posts

95%

Other mixed resins lumber timers and posts

95-100%

Latex Paint; white, off-white or pastel colors

20%

Latex Paint; gray, brown, earth-tones, 50-99%

TOTAL RECOVERED

MATERIALS

CONTENT (RMC)

ACTUAL

RMC (%)

QUANTITY

USED

EXEMPTION

(1,2,3) other dark colors

Consolidated Latex Paint (when color and performance doesn’t matter)

100%

Plastic Non-road Signs 80-100%

Aluminum Signs 25%

Plastic Sign Posts and Supports 80-100%

Steel Sign Posts and Supports 25-30%

BOF/100%EAF

Awards and Plaques

Glass 75-100

Wood 100%

Paper 40-100

Plastic and Plastic/ Wood Composite

50-100

The following exemptions may apply to the non-procurement of recycled/recovered content materials:

1. The product is not available from a sufficient number of sources to maintain a sufficient level of competition (i. e., available from two or more sources) or is not available a reasonable price.

2. The product is not available within a reasonable period of time.

3. The product does not meet the performance standards in applicable specifications to fails to meet reasonable performance standards of the agency.

CERTIFICATION

I hereby certify the Statement of Work/Specifications for the requisition/procurement of all materials listed on this form comply with EPA standards for recycled/recovered materials content.

CONTRACTOR DATE