CN-370000-LE807-3I-71847.pdf
PDF 128 KB Posted
- Contract number
- LE807
- Issued by
- Florida
About this file
This Work Authorization Form (WAF OER_13, effective July 1, 2017) is issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), authorizing work under contract LE807 with ACT Inc. The form authorizes emergency response services for DEP Incident #2024-3I-71847, dated December 13, 2024, located at I-75 North mile marker 210 in Sarasota County, Florida. The on-scene coordinator is Sam Walch, and the contractor representative is Jason Huffman.
The authorized work consists of mobilization and inspection for cleanup of a vegetable oil spill involving 700 gallons. The level of effort includes one supervisor and one equipment operator, utilizing a response truck, with PPE Level D required. The work assignment is structured as a fixed-price contract with a not-to-exceed estimate of $2,300. Funding is allocated from project LE807 using organization code 37040100000, object code 131545, fund category 099001, with the amount of $2,300.00. The work authorization was approved by DEP Representative Sam Walch (January 29, 2025), Contractor Representative Jason Huffman (January 13, 2025), and OER Budget Representative Vickie Koenig (February 3, 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 inc. 2024-3I-71847
LE807 Jasson Huffman 12/13/2024
I-75 N mile marker 210 Sam Walch
I-75 N Mile marker 210 SD
Sarasota Sarasota (239) 810-9505
Vegetable oil, 700 gallons
1 D
LE807 37040100000 FC 131545 099001 101492 2,300 00
Sam Walch 1-29-25
Jason Huffman 1-13-25
Vickie Koenig 2/3/2025
Samuel Graves
Mobilization and inspection for cleanup quote
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.02.03 14:33:37 -05'00'
Jason Huffman Digitally signed by Jason Huffman Date: 2025.01.13 15:52:55 -05'00'
Sam Walch Digitally signed by Sam Walch Date: 2025.01.29 10:05:31 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.02.03 15:18:14 -05'00'
File details come from the government source that posted it. Updated .