CN-370000-LE807-3I-66801.pdf
PDF 243 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The document authorizes work under Contract LE-807 with contractor ACT for incident 2021-3I-66801 occurring on January 4, 2021, at the intersection of SR 82 & I75 in Fort Myers, Lee County, Florida. The incident was overseen by On-Scene Coordinator Lina Ramirez, with Jason Huffman serving as the contractor representative and Melissa Woehle as the DEP budget representative.
The work encompasses spill response and soil remediation activities related to diesel contamination totaling 20 gallons. The scope includes soil removal, sampling, backfill, sod restoration, Organic Vapor Analyzer (OVA) readings, disposal, and shoulder closure. Labor requirements consist of three recovery technicians, one for each phase of assessment, excavation, and disposal, plus truck drivers for excavation and disposal operations. Equipment includes one steakbed truck, one mini dump truck for excavation, and one for disposal, along with work clothes and a diesel cost of $9,500. The work was assigned as a fixed-price contract with a not-to-exceed amount of $9,500, funded under Project LE807, Organization Code 37040100000, EO FC, Object Code 139900, Fund 099001, and Category/Year 101492. The authorization was approved on January 19-20, 2021, with final budget approval on January 21, 2021.
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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
Response Truck Overpack Drums: Visqueen
Straight Truck 55-gal. Drums: Roll-off Containers: ___________
Vacuum Truck Sampling Gear EPA Level 1 Vapor Detector
Pickup or Van Sampling Gear EPA Level 2 PPE Level: __________________
Supervisor: ____
Recovery Tech: ____
Equip. Oper.: ____
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
ACT 2021-3I-66801
LE-807 Jason Huffman 1/4/2021
SR 82 & I75 Lina Ramirez
Intersection of SR 82 & I75 239-344-5623
Fort Myers Lee 239-770-7418
Diesel, 20 gallons
Work clothes
1 Recovery tech for day of assessment, 1 recovery tech for day of excavation, 1 truck driver for day of excavation, 1 truck driver for day of disposal
1 steakbed truck, 1 mini dump truck for excavation and 1 for disposal day
$9,500
Lina Ramirez 1/19/2021
Jason Huffman 1-19-21
Melissa Woehle
Diesel Contaminated Soil
Backfill, Sod, OVA, Disposal, shoulder closure
Jason Huffman Digitally signed by Jason Huffman DN: cn=Jason Huffman gn=Jason Huffman c=United States l=US o=ACT ou=Emergency Response e=jhuffman@act.com Reason: I have reviewed this document Location:
Date: 2021-01-19 12:37-05:00
Lina Ramirez Digitally signed by Lina Ramirez Date: 2021.01.19 12:31:01 -05'00'
Melissa Woehle Digitally signed by Melissa Woehle Date: 2021.01.20 14:05:17 -05'00'
LE807 37040100000 FC 139900 099001 101492 9500
Kristin Gousse 1/21/21
File details come from the government source that posted it. Updated .