CN-370000-LE807-3I-71535.pdf
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- Contract number
- LE807
- Issued by
- Florida
About this file
Work Authorization Summary
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection, Office of Emergency Response, for emergency response services. The document authorizes work under Contract LE807 with contractor ACT in response to DEP Incident #2024-3I-71535, dated September 11, 2024. The incident location is NB 41 & Highland Woods Boulevard in Bonita Springs, Lee County, Florida. The On-Scene Coordinator is Dave Glen, with primary contact at 239-633-5441.
The authorized work encompasses spill response and soil removal services related to diesel-impacted materials, specifically addressing seven drums containing impacted soil and spent absorbent. The work assignment is structured as a fixed-price contract with a total authorized amount of $15,500.00. The level of effort includes one supervisor and two recovery technicians, along with one response truck and one straight truck. Equipment specifications include a vapor detector, PPE Level D, and MOT. Work will be conducted with analytical and disposal arrangements profiled as diesel-impacted materials. Funding is allocated from Project LE 807, Organization Code 3704 0100 000, EO Code FC, Object Code 131545, Fund 099001, Category/Year 101492. The work authorization was executed with signatures from DEP Representative Dave Glen (9/13/2024), Contractor Representative Jason Huffman (9-13-24), and OER Budget Representative Vickie Koenig (2-11-2025).
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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
ACT 71535
LE807 J. Huffman 9/11/2024
NB 41 & Highlands Wood Blvd Dave Glen
NB 41 & Highland Woods Blvd 239-633-5441
Bonita Sprigs Lee 239-633-5441
7 drums w/ impacted soil and spent absorbent
D
15,500.00
LE 807 3704 0100 000 FC 131545 099001 101492 15,500 00
Dave Glen 9/13/2024
Jason Huffman 9-13-24
Vickie Koenig 2-11-2025
Samuel Graves
✔ Diesel Impacted materials
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.02.11 15:07:22 -05'00'
Jason Huffman Digitally signed by Jason Huffman Date: 2024.09.13 13:51:54 -04'00'
David Glen Digitally signed by David Glen Date: 2024.09.13 13:40:27 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.02.12 15:38:21 -05'00'
File details come from the government source that posted it. Updated .