CN-370000-LE807-3I-70953.pdf
PDF 555 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection, Office of Emergency Response. The form documents emergency response work authorized under Contract #LE807 with ACT (Cuzo's Logistics & Transportation LLC) in response to DEP Incident #2024-3l-70953 occurring on March 9, 2024 at a site located in Fort Myers, Lee County, Florida. The authorized representative for DEP is Heidi Hoffman, with Lauren Johnson serving as the contractor's representative.
The work authorization authorizes spill response and soil removal services related to a hydraulic fluid spill (20 gallons) and motor oil spill (10 gallons), with materials to be classified as Petroleum, Non-Hazardous. The scope includes deployment of two supervisors, one recovery technician, and one field chemist, along with specialized equipment including one response truck, one pickup/van, one backhoe, visqueen, two 55-gallon drums, two roll-off containers, work clothes PPE, and a temporary monitoring well. The work is authorized as a fixed-price engagement with a not-to-exceed estimate of $22,000.00, funded through Project No. LE 807 using Organization Code 3704 0100 000, EO code FC, Object Code 131545, and Fund 0990001 for Category/Year 101492. The work authorization was executed and approved on March 22, 2024, with budget approval on March 28, 2024.
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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
File details come from the government source that posted it. Updated .