Exhibit_33 _1_Oct_15.pdf
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Exhibit 33 SOW Appendix F HJB Form 225
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HJB Form 225, MAR 2014
SUSTAINABLE ACQUISITION EXCEPTION
Joint Base Lewis-McChord, WA
POINT OF CONTACT AND ORGANIZATION INFORMATION
1. Name 2. Title 3. Telephone
4. Organization 5. E-mail 6. Fax
CONTRACT INFORMATION (if related to a contract action, otherwise leave blank) Contracting Officer, Contracting Officer's Representative, or Project Manager Contact Information
7. Name 8. Organization 9. Phone 10. Email
11. Address
Project/Service Information
12. Project/Service Name 13. Contract Number or Other Identifier
EXCEPTION
14. Requirement Against Which Exception is Claimed (Check all that apply)
15. Reason for Exception (Check all that apply and provide details at section 18)
Recycled/Recovered Materials Price/Cost Biobased Content Life Cycle Cost WaterSense (water efficiency) Performance/Functional Requirements Energy Star/FEMP (energy efficiency) Availability EPEAT Statutory Exemption Low Emitting Materials Rapidly Renewable Materials Sustainble Wood
RESEARCH
16. List All Products/Services Researched and Vendors/Sources Consulted in Making Exception Determination
PRODUCT INFORMATION
17. Non-Compliant Product or Service that Will be Used (Supply or attach product name, national stock number, product code, description and other identifying information, as applicable)
HJB Form 225, MAR 2014
18. Cost (per unit of measure)
JUSTIFICATION*
19. Supply information justifying the use of the exception below AND attach any supporting documentation
* Justification must demonstrate the unsuitability of all available compliant options based on cost, availability, functional requirements, or performance.
Cost comparisons must show that all compliant options are only available at an unreasonable price or have higher life cycle costs than a non-Energy Star/FEMP/WaterSense product.
Life cycle cost determination shall be per 10 CFR 436, subpart A (http://www.gpo.gov/fdsys/) or another method determined to be equivalent by the DoD.
For exceptions based on statutory requirements and/or requirements based on standing orders for the maintenance and operation of U.S. Armed Forces tactical equipment, attach a photocopy of the applicable regulation/military specification.
ORGANIZATIONAL APPROVAL (approving official signature below, if required by your organization --otherwise, leave blank)
Signature Date
Return form and copies of supporting documents to usarmy.jblm.imcom.list.dpw-green-procurement@mail.mil. If related to a contract, submit to appropriate contracting official with the above address in the cc line, or ask that they forward a copy to the JBLM Sustainable Acquisition Program Coordinator (Bldg 1210, 966-6466). Supporting documents can include catalog data, technical data sheets, price listings, life cycle cost calculations, etc.
DPW ED 9/21/15
INSTRUCTIONS FOR COMPLETING HJB FORM 225
(SUSTAINABLE ACQUISITON EXCEPTION)
Blocks 1 through 6: Contact Information. For the main point of contact attached to the exception determination, enter name, title/position, telephone number, organization name, email, and fax number (if applicable).
Blocks 7 through 13: Contract Information. As the name suggests, this block is only applicable to products/services supplied as part of a contract action. Contract actions will include the name of the project Contracting Officer or COR and their contact information. Also include the project number (e.g., contract and task order identifiers) and name.
Blocks 14 and 15: Exception Information. Check the box(es) for the requirement being excepted as well as the reason for the exception.
Block 16: Research Information. List or describe the type of product being procured and enter all sources consulted to determine the feasibility of compliant options.
Sources may include vendors/suppliers, manufacturers, websites, or a combination thereof. If an applicable program website includes a listing of compliant models (e.g., BioPreferred, Energy Star, EPEAT, or WaterSense), it must be consulted. Mandatory sources of supply, such as Office Product BPA/FSSI vendors, must be consulted but need not be utilized if they cannot supply compliant items in contrast to other vendors.
Blocks 17 and 18: Product Information. Include the name and identifying information of the excepted non-compliant product to be procured. Identifying information can include national stock number, product code, physical description, etc. Include the vendor/supplier name and their location as well as product cost and unit of measure.
Block 19: Justification. Include specific justification.
If claiming a price exception, state the difference in cost between the non-compliant product/service to be procured and the cheapest feasible compliant option. If excepting energy-consuming or water-emitting products or services, cost differential must be based on life cycle cost as determined by 10 CFR 436 Subpart A. For such items/services, submit life cycle cost analysis with the form.
If claiming an availability exception, list the timeframe within which the product is needed and the reason why it cannot be extended.
If claiming a performance exception, either (1) state a performance standard and describe how you determined that no compliant options can meet it; or (2) describe previous in-house testing that has proven compliant options unfeasible
DPW ED 9/21/15
due to poor performance. For in-house testing, list products tested, dates of testing, and performance shortfalls. Also verify and state that manufacturers of these products were consulted and that no reformulations/improvements have been made since the time of the previous testing. Moreover, describe the nature of the testing (processes used, performance criteria, etc).
Organizational Approval. This block is present for use by organizations seeking to exercise more centralized control over their exception process. Signed organizational approval is not currently required at the installation level, although any exception must meet the legal criteria within the applicable law(s).
Submittal Instructions:
For contract actions, the form will be submitted to the project manager or COR for review. The COR will forward a copy to the Sustainable Acquisition Program at usarmy.jblm.imcom.list.dpw-green-procurement@mail.mil.
Obtaining a current version of the form: The most current version of the form will be available at http://www.lewis-mcchord.army.mil/designstandards/pdf/HJB%20225.pdf.
For general information regarding sustainable acquisition:
http://www.sftool.gov/greenprocurement https://www.whitehouse.gov/omb/procurement_index_green/
| Appendix F - Green Procurement Exception Form HJB 225 |
| Appendix F - HJB Form 225 instructions |
| 1 Name: |
| 2 Title: |
| 3 Telephone: |
| 4 Organization: |
| 5 Email: |
| 6 Fax: |
| 7 Name: |
| 8 Organization: |
| 9 Phone: |
| 10 Email: |
| 11 Address: |
| 12 ProjectService Name: |
| 13 Contract Number or Other Identifier: |
| Check Box 1: Off |
| Check Box 9: Off |
| Check Box 2: Off |
| Check Box 10: Off |
| Check Box 3: Off |
| Check Box 11: Off |
| Check Box 4: Off |
| Check Box 12: Off |
| Check Box 5: Off |
| Check Box 13: Off |
| Check Box 6: Off |
| Check Box 7: Off |
| Check Box 8: Off |
| 16 List All Products/Services Researched and Vendors/Sources Consulted: |
| 16 Non Compliant Product or Service: |
| 17 Cost per unit of measure: |
| 18 Supply Information: |
| Date (MM/DD/YYYY: |
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