LEED PRODUCT SUBMITTAL DATA FORM 1of2 Project: Architect: 81 Specification Section: No. 7 ‘Supplier /Subcontractor:_CBIS, Inc. Contact;_D-L.Nickerson Phone#: (800) 628-8476 Fax#:___(508) 867-5702 ww. Cbisinc.com Date: Project Number. Product; BXPandable Polystyrene (EPS) ‘Insulation Inserts for Concrete Blocks Manufacturer; CBIS, Inc. Contact:_D-L- Nickerson Phone # (800) 628-8476 Fax (508) 867-5702 www, cbisinc.com PRODUCT CERTIFICATION: MR 4.1 & 4.2~ Recveled Content Does this product have any recycled content?” _¥ES if Yes, fil out the following information: Post Consumer Recycled Content: (% by weight) Pre Consumer Recycled Content: (% by weight) 10 ~ 12 Description of Recycled . . Content. Reeyeled rejected inserts Concrete Subs: Separate Material Submittal Data Sheets are ‘required for cementitious materials in concrete (including Fly. Ash, "Netos: Recycled content documentaton must be atached. CS! Saco 1418, 46,2827 ae expt tom the cea MR 5.1 — Regional Materials Was a portion ofthis product extracted, harvested or recovered, as well as manufactured within 500 miles of the project site?_NO tyes, fil out the folowing information: Percent compliant by weight (%) Harvest Distance (mi) Manufacture Distance (i) Notes: Vencaton tar om the manvacturer mut be atached. CS! Sectons DO ereelgale fortis edt MR6 apidly Renowable Materials Does this product have any rapidly renewable materials (plants that are harvested within 10 years of planting) such as Bamboo, woo, cotton, agiiper, lincleum, wheatboard, strawboard, and cork? Fes, fl ut the following information: Percent that meets Credit (% by weight) Description of Rapidly Renewable Material Totes ST Secions 210 ae aigine fr hs Gea MR 7 — Certified Wood ‘Does this product have wood based materials? _NO yes, fil out the following information: ‘Wood Component percentage (6) FSC Certified wood percentage (%) Product is FSC Trademarked FSC Chain of Custody certificate number is Notes: CS! Secon 210 ae ete for this rest Manuractuer ‘copy ofthe FSC Chain of Custody (COC) Cerca Nuno is roqured rom ‘ne manacrar Fe products FSC Tradomarved ers aubea, (Generetyfannestes peaucs) ‘Acopy fe FSC Chain of Custody (COC) Certoate Numbers required fom ‘he mole! vensr he product ot abeatedn FSC ceri plan for ‘hs submit Ts ince (bt ot ts) al Senos umber and ‘wood. Invices contrmang deer feared weed, avant. ard suppers {60 is ao requres to oostesuperrionden upon fal delvery of material CERTIFIED BY (Manufacturer Print Name: D-IL. Nickerson Signature ae CEO of CBIS, Inc. Di eee Note: Submittal ofthis form does not release the General Contractor from the responsibilty of completing and submitting LEED ‘Submittal Templates to USGBC at the completion ofthis project.LEED PRODUCT SUBMITTAL DATA FORM 20f2 Project: Date: Architect’ Project Number: ee Be oad Expandable Polystyrene (EPS) ee Puniration Inserts tor Concrete ‘Supplier / Subcontractor; __CBIS, Inc. Manufacturer, CBIS, Inc Blocks: Contact__D-L. Nickerson Contact__D-L. Nickerson Phone #: (800) 628-8476 Phone #:__(800) 628-8476. Fax #: (508) 867-5702 Fax #: (508) 867-5702 a cbisinc.com ea cbisinc.com COST CERTIFICATION: Total Installed Material Cost: (Excluding labor and equipment) (CERTIFIED BY (Contractor): Print Name: Signature: Tile: Date: INSTALLER CERTIFICATION: 3, 4.4 - Low emitting Mater hesives & Si Composite ‘Wood and Agrifiber Products) List requested information forthe following products used on the interior ofthe building (Inside the weatherproofing system). Refer {0 Specifications for allowable VOC limits for each product. Adhesives and Sealants (VOC content g/l) _NONE Paints and Coatings (VOC content giL)__NONE Carpet Systems (compliance with Green Label program) ___ Yes _XX_No ‘Composite wood and Agrifber contains no added urea-formaldehyde resins _ Yes ces Tectnica Data rom he manacturer must be sached. ll CSI Sctons are el frie eedinccing MEP. (CERTIFIED BY (Installer / Manufacturer / Supplier Firm): Print Name: Signature: Tite: Date: Note: Submittal of this form does not release the General Contractor from the responsibilty of completing and submitting LEED ‘Submittal Templates to USGEC at the completion of this project.