Attachment_4_Cont_Affirm_Procurement_Report.rtf

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

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.”

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 2nd column in table below).

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

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

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

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

Rubber Carpet Cushion 60-90%

Rubber Plastic Patio Blocks 90-100%

Rubber or Plastic Floor Tile

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

Attachment 0005

Channelizers, Plastic 25-95%

Channelizers, rubber base

Delineators, plastic 25-90%

Delineators, rubber base

Delineators, steel base 25-50%

Flexible plastic delineators 25-85%

Parking Stops, Plastic or Rubber

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

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

Running Tracks. Including rubber or plastic

Plastic Park benches and Picnic Tables

Plastic composite Park benches and Picnic Tables

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

Plastic Composites Playground Equipment 95-100%

Steel Playground Equipment

25-30% BOF/100% EAF

Aluminum Playground Equipment

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

Wood-based hydraulic mulch

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

HDPE lumber timbers and posts 75-100%

Mixed plastics/Sawdust lumber timbers and posts

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, other dark colors 50-99%

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

Plastic Non-road Signs

Aluminum Signs

Plastic Sign Posts and Supports

Steel Sign Posts and Supports

25-30% BOF/100%EAF

Awards and Plaques Glass 75-100

Wood

Paper 40-100

Plastic and Plastic/ Wood Composite 50-100

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

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.