CN-370000-LE807-3I-71549.pdf
PDF 179 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection (DEP), Office of Emergency Response (OER), authorizing emergency response services from contractor ACT under Contract LE807. The authorization pertains to incident #2024-3I-71549 occurring on September 23, 2024, at I-75 Canal near Mile Marker 111 in Naples, Collier County, with On-Scene Coordinator Travis Burch overseeing the response.
The work authorization covers spill response services for the removal of impacted booms and pads contaminated with approximately 40 gallons of diesel fuel, classified as non-hazardous PCW waste. The contractor shall deploy one supervisor and two recovery technicians utilizing a response truck and three 55-gallon drums, with personal protective equipment at Level D. The work is assigned on a fixed price basis with a not-to-exceed estimate of $4,000.00. Funding is provided through Project LE 807, Organization Code 3704 0100 000, EO FC, Object Code 131545, Fund 099001, and Category/Year 101492. The authorization was approved and digitally signed by DEP Representative Sam Walch on September 24, 2024, Contractor Representative Lauren Johnson on October 4, 2024, and OER Budget Representative Vickie Koenig on October 7, 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
ACT 2024 - 3I- 71549
LE807 Lauren Hufman 09/23/2024
I-75 Cannal Travis Burch
I-75 Mile Marker 111 (239) 344-5639
Naples Colier (239) 810-9505
40 gallons of Diesel fuel
D
4000.00
LE 807 3704 0100 000 FC 131545 099001 101492 4,000 00
Sam Walch 09/24/2024
Lauren Johnson 10/4/2024
Vickie Koenig 10/7/2024
Samuel Graves
✔ Non Hazardous PCW boom/Pads
Removal of impacted booms and pads
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.10.07 15:17:45 -04'00'
Lauren Huffman Digitally signed by Lauren Huffman Date: 2024.10.04 15:08:41 -04'00'
Sam Walch Digitally signed by Sam Walch Date: 2024.09.24 10:36:35 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.10.04 15:27:29 -04'00'
File details come from the government source that posted it. Updated .