Instructions WELL Certification is determined by onsite Performance Verification and documentation, including Letters of Assurance from the appropriate professionals overseeing the implementation of a specific WELL feature and component parts during design, construction or operations. The template should be completed, signed and
Contractor's Letter of Assurance Instructions v1 WELL Certification is determined by onsite Performance Verification and documentation, including Letters of Assurance from the appropriate professionals overseeing the implementation of a specific WELL feature and component parts during design, construction or operations. The template should be completed, signed and submitted as part of the documentation package. 1. Place a checkmark at every part completed and leave blank those that are not being pursued or being completed by another team member. 2. Initial every feature completed and leave blank those that are not being pursued or being completed by another team member. 3. Sign and date at the bottom of this letter. If an individual other than the Contractor is responsible for any of the requirements contained in this Letter of Assurance, he/she is permitted to sign off on the respective requirements but must complete a separate Letter of Assurance for those specific requirements. This individual should submit a different copy of this form and check the boxes as it pertains to his/her own responsibility. On his/her own Letter of Assurance form(s), this individual should sign and complete the final page and include a description of his/her role on the project next to his/her signature. AIR Check Initials 03 Ventilation effectiveness This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 3: System Balancing After the HVAC system is installed, the following requirement is met: a. After substantial completion and prior to occupancy, the HVAC system has (within the last 5 years), or is scheduled to, undergo testing and balancing. 04 VOC reduction This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 1: Interior Paints and Coatings The VOC limits of newly applied interior paints and coatings meet one of the following requirements: a. 100% of installed products meet California Air Resources Board (CARB) 2007, Suggested Control Measure (SCM) for Architectural Coatings, or South Coast Air Quality Management District (SCAQMD) Rule 1113, effective June 3, 2011 for VOC content. b. At minimum 90%, by volume, meet the California Department of Public Health (CDPH) Standard Method v1.1-2010 (or later) for VOC emissions. c. Applicable national VOC content regulations or conduct testing of VOC content in accordance with ASTM D2369-10; ISO 11890, part 1; ASTM D6886-03; or ISO 11890-2. 1 Contractor's Letter of Assurance, Q1 2019 1 AIR Check Initials PART 2: Interior Adhesives and Sealants The VOC limits of newly applied interior adhesives and sealants meet one of the following requirements: a. 100% of installed products meet South Coast Air Quality Management District (SCAQMD) Rule 1168 for VOC content. Volatile organic compound (VOC) limits correspond to an effective date of July 1, 2005 and rule amendment date of January 7, 2005. b. At minimum 90%, by volume, meet the California Department of Public Health (CDPH) Standard Method v1.1-2010 (or later) for VOC emissions. c. Applicable national VOC content regulations or conduct testing of VOC content in accordance with ASTM D2369-10; ISO 11890, part 1; ASTM D6886-03; or ISO 11890-2. PART 3: Flooring The VOC emissions of all newly installed interior flooring meet all limits set by the following, as applicable: a. California Department of Public Health (CDPH) Standard Method v1.1-2010 (or later). PART 4: Insulation The VOC emissions of all newly installed interior thermal (excluding duct) and acoustic insulation meet all limits set by the following, as applicable: a. California Department of Public Health (CDPH) Standard Method v1.1-2010 (or later). 07 Construction pollution management This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 1: Duct Protection To prevent pollutants from entering the ventilation system, all newly installed ducts are either: a. Sealed and protected from possible contamination during construction. b. Vacuumed out prior to installing registers, grills and diffusers. PART 2: Filter Replacement To prevent pollutants from entering the air supply post-occupancy, if the ventilation system is operating during construction occurring within one year prior to Performance Verification, the following requirement is met: a. All filters are replaced prior to occupancy. PART 3: Moisture Absorption Management To prevent building materials from absorbing water or moisture during construction occurring within one year prior to Performance Verification, the following requirements are met: a. A separate area is designated to store and protect absorptive materials, including but not limited to carpets, acoustical ceiling panels, fabric wall coverings, insulation, upholstery and furnishings. PART 4: Dust Containment and Removal The following procedures are followed during building construction occurring within one year prior to Performance Verification: a. All active areas of work are isolated from other spaces by sealed doorways or windows or through the use of temporary barriers. b. Walk-off mats are used at entryways to reduce the transfer of dirt and pollutants. c. Saws and other tools use dust guards or collectors to capture generated dust. 2 Contractor's Letter of Assurance, Q1 2019 2 AIR Check Initials 13 Air flush This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 1: Air Flush A building air flush is performed while maintaining an indoor temperature of at least 15 °C [59 °F] and relative humidity below 60%, at one of the following volumes: a. A total air volume of 4,266 m³ of outdoor air per m² of floor area [14,000 ft³ per ft² of floor area] prior to occupancy. b. A total air volume of 1,066 m³ of outdoor air per m² of floor area [3,500 ft³ per ft² of floor area] prior to occupancy, followed by a second flush of 3,200 m³ of outdoor air per m² of floor area [10,500 ft³ per ft² of floor area] postoccupancy. While the post-occupancy flush is taking place, the ventilation system must provide at least 0.1 m³ per minute of outdoor air per m² of floor area [0.3 CFM outdoor air per ft² of floor area] at all times. 24 Combustion minimization This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 4: Construction Equipment To reduce particulate matter emissions from both on-road and non-road diesel fueled vehicles and construction equipment, the following requirements are met for construction occurring within one year prior to Performance Verification: a. All non-road diesel engine vehicles comply with the U.S. EPA Tier 4 PM emissions standards or local equivalent when applicable. Engines may be retrofitted with verified technology (required to be U.S. EPA or California Air Resources Board approved) at the time the equipment is first placed on the job site. b. All on-road diesel engine vehicles meet the requirements set forth in the U.S. EPA model year 2007 on-road standards for PM, or local equivalent when applicable. Engines may be retrofitted with verified technology (required to be U.S. EPA or California Air Resources Board approved) at the time the equipment is first placed on the job site. c. All equipment, vehicles and loading/unloading are located away from air intakes and operable openings of adjacent buildings when available. 25 Toxic material reduction This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 2: Flame Retardant Limitation Halogenated flame retardants are limited in the following components to 0.01% (100 ppm) to the extent allowable by local code: a. Window and waterproofing membranes, door and window frames and siding. b. Flooring, ceiling tiles and wall coverings. c. Piping and electrical cables, conduits and junction boxes. d. Duct, pipe, acoustic and thermal insulation. e. Upholstered furniture and furnishings, textiles and fabrics. 3 Contractor's Letter of Assurance, Q1 2019 3 AIR Check Initials PART 3: Phthalate (Plasticizers) Limitation DEHP, DBP, BBP, DINP, DIDP or DNOP (often found in polyvinyl chloride [PVC]) are limited in the following components to 0.01% (100 ppm): a. Flooring, including resilient and hard surface flooring and carpet. b. Wall coverings, window blinds and shades, shower curtains, furniture and upholstery. c. Plumbing pipes and moisture barriers. PART 4: Isocyanate-Based Polyurethane Limitation Isocyanate-based polyurethane products are not used in: a. Interior finishes. PART 5: Urea-Formaldehyde Restriction Urea-formaldehyde presence is limited in the following components to 100 ppm: a. Furniture or any composite wood products. b. Laminating adhesives and resins. c. Thermal insulation. 26 Enhanced material safety This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 1: Precautionary Material Selection At least 25% of all furnishings, built-in furniture, interior finishes, and finish materials (calculated by cost) meet one or more of the following requirements: a. Have a Declare: Living Building Challenge Red List Free, Declare: Living Building Challenge Compliant, or Living Product Challenge label. b. Are Cradle to Cradle CertifiedTM products with a Bronze, Silver, Gold or Platinum level in the Material Health category or products with a Bronze, Silver, Gold or Platinum level Material Health Certificate from the Cradle to Cradle Products Innovation Institute. c. Have no GreenScreen® Benchmark 1, List Translator 1 or List Translator Possible 1 substances over 1,000 ppm, as verified by a qualified Ph.D. toxicologist or Certified Industrial Hygienist. 28 Cleanable environment This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 1: Material Properties High-touch and non-porous surfaces (refer to Table A1 in Appendix C) meet the following requirements: a. Smooth and free of defects visible to the unaided eye. b. Finished to maintain smooth welds and joints. c. Free of crevices and other hard-to-reach places. 4 Contractor's Letter of Assurance, Q1 2019 4 AIR Check Initials PART 2: Cleanability The following requirements are met: a. No permanent wall-to-wall carpeting is used; only removable rugs, removable carpet tiles or hard surfaces are allowed. b. The building provides adequate flexible storage space for all permanent, movable items to allow high-touch surfaces to be completely cleared during cleaning. c. Right angles between walls and windows/floors are sealed. COMFORT Check Initials 81 Sound barriers This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 2: Doorway Specifications Doors connecting to private offices, conference rooms and teleconference rooms are constructed with at least one of the following: a. Gaskets. b. Sweeps. c. Non-hollow core. PART 3: Wall Construction Methodology All interior walls enclosing regularly occupied spaces are constructed for optimal performance by reducing air gaps and limiting sound transmission through the following: a. Properly sealing all acoustically rated partitions at the top and bottom tracks. b. Staggering all gypsum board seams. c. Packing and sealing all penetrations through the wall. MIND Check Initials 97 Material transparency This project is constructed to meet the parts selected below (reproduced from the WELL Building Standard): PART 1: Material Information At least 50% (as measured by cost) of interior finishes and finish materials, furnishings (including workstations) and built-in furniture have some combination of the following material descriptions (in order to contribute, the product must indicate that all ingredients have been evaluated and disclosed down to 1,000 ppm): a. Declare Label. b. Health Product Declaration. c. Any method accepted in USGBC's LEED v4 MR credit: Building Product Disclosure and Optimization - Material Ingredients, Option 1: material ingredient reporting. 5 Contractor's Letter of Assurance, Q1 2019 5 By signing below, I represent that, to the best of my knowledge, all of the responses provided on this form are accurate and made in good faith. Printed Name: Company: Signature: Date: If the individual using this form is not in the role of Contractor, provide a description of the individual's project role, including justification of their ability to sign off on the above requirements, here: Project Role: Explanation: 6 Contractor's Letter of Assurance, Q1 2019 6Microsoft Access for Office 365 Microsoft Access for Office 365