CN-370000-LE706-2167837.pdf
PDF 131 KB Posted
- Contract number
- LE706
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), to authorize emergency response services. The contractor is Cliff Berry, Inc., operating under Contract #LE706. The work is being performed at Morning Side Picnic Island in Miami-Dade County, Florida, in response to DEP Incident #2021-2I-67837 dated July 4, 2021. The On-Scene Coordinator is Lina Cerquera, with Bill Reasoner serving as the contractor's representative.
The authorization covers the removal and transportation of 21 abandoned 20-gallon poly drums suspected to contain petroleum materials, specifically a flammable liquid mixture of gasoline and water (50%-100%). The work is assigned on a fixed-price basis at $150 per drum, with a total contract amount of $4,500. The work scope includes soil removal and drum transportation to a Treatment Storage and Disposal Facility (TSDF). Funding is allocated from Project No. LE706, Organization Code 37040100000, with Object Code 139900, Fund Category 212001, and Budget Code 104132. The authorization was approved on July 8, 2021, by DEP Representative Lina Cerquera, Contractor Representative Daniel Forehand, and OER Budget Representative Precious Boatwright.
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Text version
OER_13 (Effective 7-01-2017)
Florida Department of Environmental Protection
Office of Emergency Response
WORK AUTHORIZATION FORM
Required Signatures: Adobe Signature or Original Ink Supplemental WAF
Contractor: ____________________________________ DEP Incident # ______________________ Contract #: ___________ Rep: ____________________ Incident Date _______________________ Site Name: ____________________________________ OSC: ______________________________ Location: ______________________________________ Phone: Office______________________ City: __________________County: _________________ Cell ________________________
Description of Work: Respond Immediately Call OSC to set date/time__________________________________
Spill Response Overpack Drums Transport drums to TSA Abandoned Drum:
Remove Soil Sampling Transport Drums to TSDF Analysis of samples collected by OER
Other:
Suspected Materials, and amounts: _____________________________________________________________________________________
Level of Effort: (Check all that apply) Use Subcontractor per OSC
Personnel Vehicles Equipment
Supervisor: ____ Response Truck Overpack Drums: Visqueen
Recovery Tech: ____ Straight Truck 55-gal. Drums: Roll-off Containers: ___________
Field Chemist: ____ Vacuum Truck Sampling Gear EPA Level 1 Vapor Detector
Equip. Oper.: ____ Pickup or Van Sampling Gear EPA Level 2 PPE Level: __________________
Other: ____________ Backhoe or Similar Other: ________________ MOT
Contract Rate: ____________
Comments: ___________________________________________________________________________________________________________
Analytical & Disposal Arrangements: (analytical will usually be listed on Chain-of-Custody or other form)
Via Contractor Via Subcontractor Other: __________________________
Profile Wastes as:
Work Assignment Type: fixed price Not to Exceed estimate amount: $___________________________
Funding Information: (information provided by OER budget rep., budget rep to sign after WAF executed, but prior to transmittal to F&A)
Project No.
Organization Code
EO
Object Code
Fund
Category/Yr
Amount
Approved:
DEP Representative: __________________________ Signature: _______________________________ Date: __________________
Contractor Rep: __________________________ Signature: ___________________________________ Date: __________________
OER Budget Rep: __________________________ Signature: __________________________________ Date: __________________
Deliverable will be reviewed and evaluated by the DEP Contract Manager to ensure appropriate documentation reviewed and/or provided and that the documentation submitted is complete, accurate, and submitted timely
Cliff Berry, Inc. 2021-2I-67837
LE706 Bill Reasoner 7/4/21
Morning Side Picnic Island Abandoned Drums Lina Cerquera
Morning Side Picnic Island 239-344-5707
Miami Miami-Dade 239-633-5441
21 - 20 gallon poly drums suspected to contain petroleum materials.
$150/drum
LE706 37040100000 JC 139900 212001 104132 4,500 00
Lina Cerquera 7/8/21
Daniel Forehand 07/09/2021
Precious Boatwright
Flammable Liquid, n.o.s. (Gasoline & Water mixture 50%-100%)
✔ 21
Precious Boatwright Digitally signed by Precious Boatwright Date: 2021.07.13 10:16:18 -04'00'
Daniel T. Forehand Digitally signed by Daniel T. Forehand Date: 2021.07.09 07:44:28 -04'00'
Lina Cerquera Digitally signed by Lina Cerquera Date: 2021.07.08 16:50:52 -04'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2021.07.13 09:45:57 -04'00'
Cerquera_L Highlight
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