LEEDTM CRITERIA WORKSHEET

Project Name Project Number

Product Subcontractor Contact, Name and Phone No.

Manufacturer Name / Address Subcontractor Contact, Name and Phone No.

Spec Section Date

A. Percent post consumer1 recycled content:2 LI Yes % LI No

B. Percent pre-consumer1 recycled content. 2 LI Yes % LI No
C. Is this product, or some portion thereof, manufactured within 500 miles of the jobsite? 2 Yes No LI LI

If yes, miles and submit a

driving distance calculation from Google
Map.
D. Is this product, or some portion thereof, extracted (mined, quarried, etc.) harvested LI Ye s LI No
(farmed, logged, etc), or recovered (salvaged, reclaimed, etc.) within 500 miles of the job site?
2 If yes, miles and submit a
driving distance calculation from Google
Map.
E.Does this product use material considered to be rapidly renewable by the USGBC? 2 LI Ye s LI No
If yes, % of the material meets
the criteria.
F.Is this product, or some portion thereof, certified by the Forest Stewardship Council? 2 LI Yes No LI

If yes, %, FSC Chain-of-

Custody Certificate # .
A.Are any adhesives or sealants used in the fabrication of this product? 2 Are any LI Yes LI No
adhesives or sealants used during the installation of the product? 2
If yes, VOC g/L
B.Is this product a paint, coating, or carpet system? Carpet must meet or exceed Carpet LI Yes LI No
and Rug Institute's Green Label Plus testing and product requirements.
If yes, VOC g/L
C.Are all composite wood and agrifiber products urea-formaldehyde free? 2 (i.e. particle L I Ye s L I No L I N/A
board, medium density fiber board (MDF), plywood, wheatboard, strawboard, panel
substrates, or door cores). (No added urea-formaldehyde resins are permitted in this
project.)

A.What is the material cost? Do not include labor and equipment. $ .

1 Post consumer recycled content includes materials reclaimed for consumer products that would normally be disposed of as solid waste. Pre-consumer recycled content
includes materials diverted from the waste stream that cannot be reused in the same industrial or manufacturing process. If the recycled conent is part of an assembly or mixture (ex:
concrete fly ash), use the following formula:

Total Recycled Content (%) = Component Weight (lbs.) x Recycled Content (%)
Total Weight (lbs.)

2 If the answer is yes, attach supporting documentation in the form of an affidavit letter and/or product date sheet(s) including any LEED related documentation.
I certify that the information provided above is accurate to the best of
my knowledge and I have read Division 01 of the Specifications
Printed Name and Title Signature Company Date