CN-370000-LE808-2I70041S.pdf
PDF 130 KB Posted
- Contract number
- LE808
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The document authorizes work under Contract LE808 with AOTC (Alpha Omega Technical Consulting), with Kirk Kraus serving as the contractor representative. The authorization pertains to incident 2023-2I-70041, a Hollywood Plane Crash occurring on 5/17/2023 at Hollywood Plaza, 201-225 N Park Road, Hollywood, Broward County, Florida. The incident was reported by On-Scene Coordinators Deluna and George.
The authorized work consists of spill response services focused on vacuuming a storm drain and proper disposal of petroleum materials from the plane crash. The contractor mobilized one supervisor, one recovery technician, a response truck, vacuum truck, and three 55-gallon drums for this effort. Analytical and disposal arrangements are to be handled via the contractor, with petroleum identified as the profiled waste material. The work is assigned as a fixed-price project with a not-to-exceed estimate amount of $2,000. Funding is sourced from Project LE 808, Organization Code 3704 0100 000, Object Code 131545, Fund Category 0990001, and account 101492. The work authorization was executed with digital signatures from DEP Representative Joseph DeLuna (3/18/2024), Contractor Representative Kirk Kraus (3/26/2024), and OER Budget Representative Vickie Koenig (3/26/2024).
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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
AOTC 2023-2I-70041
LE808 Kirk Kraus 5/17/2023
Hollywood Plane Crash Deluna and George
Hollywood Plaza 201-225 N Park Rd 561-681-6767
Hollywood Broward 954-658-8020
Petroleum from plane crash
LE 808 3704 0100 000 FC 131545 0990001 101492 2,000 00
Joseph DeLuna 3/18/2024
Kirk Kraus 3/26/2024
Vickie Koenig 3/26/2024
Samuel Graves
Petroleum
✔ ✔ 3
Vacuum Storm drain and proper disposal
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.03.26 12:02:03 -04'00' kirk kraus Digitally signed by kirk kraus DN: cn=kirk kraus, o=Alpha Omega, ou, email=kkraus@a-otc.com, c=US Date: 2024.03.26 08:55:38 -04'00'
Joseph Deluna Digitally signed by Joseph Deluna Date: 2024.03.18 15:22:38 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.03.26 11:54:20 -04'00'
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