Attachment_4_-_Contractor_Affirmative_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 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.

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 5th 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%

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RECYCLED OR RECOVERED

PRODUCT

TOTAL

RECOVERED

MATERIALS

CONTENT (RMC)

ACTUAL RMC

QUANTITY

USED

EXEMPTION

(1,2,3)

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%

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

100%

Attachment 5

Attachment #4

RECYCLED OR RECOVERED

PRODUCT

TOTAL

RECOVERED

MATERIALS

CONTENT (RMC)

ACTUAL RMC

QUANTITY

USED

EXEMPTION

(1,2,3) clippings, and food waste 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, other dark colors

50-99%

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

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