Environmental Building Materials Certification Form (LEED)
Contractor: Ashworth Creative Project Name:
Contact Name: Ashworth Creative Tel#: 845-877-0410

Package Pavement

P.O. Box 408
Stormville, NY 12582
P (845) 221.2224 F (845) 221.0433
www.packagepavement.com

Product Vendor or Manufacturer
(Source City, State)
Total
Installed
COST
Material
COST
(excluding
labor &
equipment)
Contains Recycled
Content?
Manu-
factured
within
500 miles
(Y/N)
% Raw Materials
Extracted within
500 Miles.
(% by weight)
Miles from
source to
Package Pavement
Miles from
source to
project site
% Post
Consumer
% Post
Industrial
LEED Form Generator Package Pavement
Stormville, NY
0% 0% N N/A N/A 0
LEED Form Generator
,
0% 0% N N/A N/A 0

Notes/Definitions:

  1. Post-Consumer Recycled Content: Portion of material or product derived from discarded consumer waste that has been recovered for use as a raw material (e.g. plastic bottles).
  2. Post-Industrial Recycled Content: Portion of material or product derived from recovered industrial and manufactured materials diverted from municipal solid waste for use in a different manufacturing process prior to use by a consumer (e.g. fly-ash in concrete).
  3. Manufactured: Blending of the raw materials into the final product. (e.g. Type N Mortar is manufactured in Stormville, NY)
  4. Raw Materials: Virgin or recovered resources from which the product’s components are made (i.e. before processing or manufacturing). If a fraction of the material is extracted / recovered within a 500 mile radius from the project, and 1/2 is outside that radius than the Raw Materials Extraction Value would be 50%.
  5. Miles to Source: Distance from the Source to the jobsite of the final manufactured material and the source materials.

Contractor Certification:

I, Gerald Guerro, a duly authorized representative of PACKAGE PAVEMENT Co. Inc., hereby certify that the information contained herein accurately represents the listed “green building” characteristics of the materials to be provided by our company as components of the building construction. Furthermore, I understand that any change in such “green building” material characteristics during the purchasing and/or installation period will require prior written approval from the Construction Manger and Owner.

Signature of Authorized Representative: Signature Date: 2013-11-07 PPLEED_13/14 -JD