Leadership in Energy

4 days ago

Grande Prairie, Canada West Coast Pro Brick & Block Ltd Full time

**Blue Hills Community School Section 01 60 13a**

**104008, Range Road 180, Mackenzie County, AB LEED® Conformance Form**

**2021-11-02 revised Page 1**

Complete a separate LEED Product Compliance Form for each product. Products submittals will be rejected if they do not have a completed copy of this form and highlighted supporting documentation.

Contractor Name: Contractor Contact:
Product Name: Product Description:
Manufacturer: Material Cost*:

- cost excluding labour, including overhead and profit. Material cost is required. _

**v4.1 MRc2 Option 1: Environmental Product Declarations**

Complete for products/materials with an Environmental Product Declaration.

☐ Industry-Wide
Environmental Product

☐ Yes ☐ No Classification: ☐ Product Specific Type III
Declaration (EPD):
☐ Life-Cycle Assessment

☐ I have attached the Environmental Product Declaration.

**v4.1 MRc3 Responsible Sourcing of Raw Materials**

Complete for products/materials that have any of the following attributes:
Extended Producer Responsibility ☐ Yes ☐ No Bio-based Content (%):
Material reused/salvaged/refurbished ☐ Yes ☐ No Wood Products - FSC Content (%):
Pre-Consumer Recycled Content (%): FSC Chain of Custody #:
Post-Consumer Recycled Content (%):
☐ I have attached manufacturer’s documentation with info above highlighted.

☐ I have attached invoices confirming FSC content, COC number, and cost.

Complete for products/materials extracted, manufactured, and purchased within 160km of the project.

City Province/State Distance from Project (km)

Extraction location:
Manufacturing location:
Purchase location:
☐ I have attached manufacturer’s documentation with location of extraction, manufacture, & purchase highlighted.

**v4.1 MRc4 Option 1: Material Ingredient Reporting**

Complete for products/materials that report chemical inventory to **1,000 ppm** using one of:
Health Product Declaration (HPD) ☐ Full disclosure of known hazards, compliant with HPD Open Standard

☐ Red List Free If ‘LBC Red List
☐ content inventory to

Declare product label ☐ LBC Red List Free Approved’ or
1,000 ppm

☐ Declared ‘LBC Compliant’

If C2C Certified, ☐ Bronze
☐ Material Health Certificate

Cradle to Cradle (C2C) has Material Health ☐ Silver
☐ C2C Certified, version 3 or later achievement level: ☐ Gold

Product Lens by UL ☐ Has Product Lens certificate

FACTS ☐ NSF/ANSI 336 at any certification level

Living Product Challenge ☐ Has Declare label w/ inventory to 0.1% (1,000 ppm)

Global Green TAG PHD ☐ Label issued after January 1, 2020

Manufacturer Inventory Listing: ☐ Complete content inventory AND ☐ Content inventory to 1,000 ppm

☐ Earned 3 points under 7.5.1.3 Advanced Level in e3-2014
ANSI/BIFMA e3 Furniture

☐ Earned 3 points under 7.4.1.3 Advanced Level in e3-2012

☐ I have attached the certificate/report checked above, with 1,000ppm testing level highlighted.

**Blue Hills Community School Section 01 60 13a**

**104008, Range Road 180, Mackenzie County, AB LEED® Conformance Form**

**2021-11-02 revised Page 2**

**v4.1 IEQc3: Low-Emitting Materials**: Complete this page for all products _inside the waterproofing membrane_.

**All products except composite wood**:
Wet-applied products: Solid products:
☐ paints and coatings ☐ wall panels

Product classification: ☐ adhesives and sealants ☐ ceilings

☐ insulation (thermal and acoustic)

☐ flooring

VOC content Max VOC Estimated

For wet
- (g/L): content allowed: volume (L): applied Max VOC ☐ CARB 2007 Suggested Control Measure (SCM) for Architectural Coatings products content per: ☐ SCAQMD Rule 1113, February 5, 2016 (paints and coatings)

☐ SCAQMD Rule 1168, October 6, 2017 (adhesives and sealants)

Inherently non-emitting ☐ Has no binders, surface coatings, or sealants that include organic chemicals.

Salvaged and reused ☐ Product is more than one year old at time of use. If finishes applied on-site, finishes must meet VOC emissions evaluation AND VOC content evaluation requirements.

VOC Emissions Evaluation ☐ Emissions Certificate, completed ☐ Certified Green by MAS reported using using California Department of ☐ Clean Air GOLD by Intertek

Public Health (CDPH) Standard ☐ Green Label Plus by CRI
Method **v1.2 - 2017**

☐ NSF/ANSI 140 multi-attribute
☐ GREENGUARD Gold by UL certifications
☐ ClearChem by Berkeley Analytical ☐ NSF/ANSI 332 multi-attribute
☐ Indoor Advantage Gold by SCS certifications
☐ FloorScore by SCS ☐ VOC Green Program by Benchmark
☐ CHPS Products by Collaborative for International

High Performance Schools ☐ other: _____________

☐ I have attached manufacturer’s documentation (MSDS/SDS) for wet-applied products, with VOC content highlighted.

☐ I have attached the VOC Emission Evaluation Report checked above, with **v1.2-2017** highlighted.

**Composite wood products**:
Formaldehyde Emissions ☐ CARB Ultra-Low-Emitting Formaldehyde (ULEF) Certif

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