APPENDIXD–LEEDMaterialsandProductForm(LEED-MF)

ProjectName&Address Relocation of the Canadian Embassy

Material/ProductName Bullet-resistant steel plate

Material/ProductUse Wall Partition

CSIDiv/SpecificationSection Section 05 50 00 – ref: 2.1.3

SUBCONTRACTOR/SUPPLIER MANUFACTURER

Name:L&Q VIET NAM TRADE AND MECHANICAL Name:……………………………

CONSTRUCTION COMPANY LIMITED
Address:: ………………………
Address: Quyet Tien Village, La Phu Ward, Hoai Duc District, Hanoi
City, Vietnam
Email:cokhingocquang@gmail.com Email:………………………
Phone: +84934617076
Material/Productcost,Taxesincluded,Installationlaborexcluded: N/A

Does the material have an EPD? No Generic Specific

EPD Yes EPD Type
(Environmental Product Declaration)

Percentage(%) Pre-Consumer N/A

RecycledContent
Percentage(%) Post-Consumer 25%
Materials Reuse Percentage(%)Salvaged orReused N/A
Components’ExtractingPlaceAddress N/A

Local criteria Products’ManufacturingPlaceAddress N/A

Products’PurchasingPoints Address N/A

Yes No
TheWoodProductis ForestStewardshipCouncil(FSC)certified
☐
Sourcingof FSC
Raw Wood Products
Materials Percentage(%)ofFSC Certified N/A
ChainofCustodyCertificationNumber(#COC) N/A

Supplier Bill willbetransmittedassoonastheWood Productis purchased Yes

Percentage(%)MeetingSustainableAgricultureNetworkStandard(example:
Bio-based Materials N/A
RainforestAlliancecertification)
Is the product part of an Extended Producer Responsibility (EPR) Closed Loop of Yes No
Extended Producer Take Back Program
Responsibility (EPR) ☐ ☐

Percentage(%)ExtendedProducer Responsibility N/A

ExtractionReporting:Doestheproduct have CorporateSustainabilityReportType N/A
Yes No
a Corporate Sustainability Report? (ex:GRI, EthicalQuote, other)
DoesthematerialhaveaMaterialIngredientReportingamong these ones?
Material HealthProductDeclaration(HPD) Cradle-to-Cradle GreenScreen REACH List
Ingredients TypeofReporting Yes No
Report(s) is/aretransmitted
☐

Product’sVolatileOrganicCompounds(VOC) Content N/A

Volumeapplied onsite(onlyforpaints,coatingsand adhesives) N/A
Low- Yes No
Emitting CDPHCertifications Green Label Floorscore Greenguard Certificatetransmitted
Materials ☐

Yes No
Confirmationofabsenceofanyaddedureaformaldehyde inStratified WoodandAdhesive
☐

I,L&Q VIET NAM TRADE AND MECHANICAL CONSTRUCTION COMPANY

LIMITED,declarethattheaboveinformation
isconsistentwiththeproductsprovidedtothecontractorforthecurrentprojectandthatthemanufacturer’sproofof the
requested information is included.

Name Signature Date:

Instructions for completing the Materials Information Form:

1. Completealltheboxesthatrelatetothesuppliedproduct.Whenthecriteriondoesnotapply,pleaseindicateN/
A.Iftheformisincomplete,itwillbereturnedwiththemention“toberesubmitted”.
2. ThisinformationiscollectedforLEEDcertificationpurposesonlyanddoesnotaffectthestandardpaymentrequest
process in any way.