4_-_Contractor_Request_for_Waiver.pdf

Contractor Request for Waiver

For Non-EPA Comprehensive Guideline Items

Contract No. ______________________________

This form is to be completed by the contractor when items subject to ANAD’s Affirmative

Procurement (AP) Policy are not purchased. This form is required for all contracts (including services using such items). NOTE: The Contractor must obtain signature of the Contracting

Officer indicating concurrence of the waiver.

INSTRUCTIONS

1. List the EPA Guidelines item(s) not procured, check the appropriate justification(s), provide a written explanation and sign and date the form.

2. Obtain Contracting Officer for waiver concurrence.

3. Submit the original approved form to the Directorate of Contract and retain copy for

Contractor files.

4. The Contracting Officer will provide a copy of the completed signed form to the

Directorate of Risk Management Pollution Prevention Program Manager.

EPA Guideline item not purchased below (refer to EPA Guideline Items list):

Products containing recovered materials and meeting ANAD’s AP standards for the above EPA

Guideline Items were not obtained because items:

_____ Do not meet all reasonable performance specifications.

_____ Are not available within a reasonable period of time.

_____ Use of minimum content standards would result in inadequate competition.

_____ Products containing recovered materials would require paying a price premium.

5. Written Justification For Not Purchasing EPA Guideline Items

(continue on back if necessary):

Contractor Signature Date

6. CONCURRENCE ___________________________________DATE

Contracting Officer

7. DATE SUBMITTED TO THE POLLUTION PREVENTION MANAGER

– Also referred to as recovered material content items

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