CN-370000-LE807-3I-71959.pdf
PDF 179 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 (FDEP), Office of Emergency Response (OER), authorizing emergency response work under Contract LE807 with ACT. The form documents authorization for spill response and remediation services at the I-75 MM 128 off-ramp in Fort Myers, Lee County, Florida, in response to DEP Incident #2025-3I-71959 dated January 13, 2025. The On-Scene Coordinator is Dave Glen, with contact information provided for coordination and oversight.
The work authorization covers spill response, soil removal, and transport of diesel-impacted materials measuring approximately 8 feet by 10 feet by 5 feet deep from the incident site. Services include supervisor and general scientist personnel, equipment operators, pickup/van and backhoe deployment, roll-off containers (1 @ 15 cubic units), vapor detection, and personal protective equipment (Level D). The contract is structured as a fixed-price assignment with a not-to-exceed estimate of $14,000.00. Work scope includes material-of-trade (MOT) documentation, soil disposal, backfill provisions, and provisions for soil confirmation sampling for Table C analysis if necessary. Funding is authorized under Project No. LE807, Organization Code 37040100000, Object Code 131545, Fund Category 099001, and Account 101492. The work authorization was approved and signed by all required parties on January 31 and 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 2025-3I-71959
LE807 Tim Bosetti, PE 1/13/2025
I-75 MM 128 (Off-Ramp) Dave Glen
I-75 MM 128 239-633-5441
Ft. Myers Lee 239-633-5441
Dave Glen 239-633-5441
Diesel Impacted Soil Approx 8' x 10' x 5' deep
1 @ 15 CU
1 D
Gen Scietist
MOT, soil disposal and backfill, provisions included for soil confirmation samples for Table C KAG. (if necessary)
14,000.00
LE807 37040100000 FC 131545 099001 101492 14,000 00
David Glen 1/31/2025
Timothy G. Bosetti, PE, PMP 1/31/2025
Vickie Koenig 2/3/2025
Samuel Graves
✔ Diesel impacted materials
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.02.03 14:24:57 -05'00'
Timothy G Bosetti Digitally signed by Timothy G Bosetti Date: 2025.01.31 11:01:34 -05'00'
David Glen Digitally signed by David Glen Date: 2025.01.31 10:32:43 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.01.31 15:28:32 -05'00'
File details come from the government source that posted it. Updated .