CN-370000-LE809-2I-73620.pdf
PDF 158 KB Posted
- Contract number
- LE809
- 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 for emergency response services. The document authorizes work under Contract LE809 between the State of Florida and Cliff Berry INC for response to a spill incident at Glades Formulating Group in Belle Glade, Palm Beach County. The incident occurred on March 24, 2026, with On-Scene Coordinator Joseph De Luna overseeing the response. The form was executed with digital signatures from all required parties between March 24 and April 16, 2026.
The authorized work involves spill response and overpacking of 12 drums containing suspected materials at the site. The scope includes one supervisor, three recovery technicians, and two field chemists using one response truck and pickup/van vehicles, along with nine overpack drums and Visqueen materials. The work is assigned on a fixed-price basis with a not-to-exceed estimate of $10,000. Funding is provided from Project LE 809, Organization Code 3704 0100 000, with Object Code 131545, Fund Category 099001, and Category/Year 101492, totaling $10,000.00. The contractor is responsible for all analytical and disposal arrangements for the profiled wastes, with work to commence upon OSC authorization.
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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
Cliff Berry INC 2026-2I-73620
LE809 Jon Hines 3/24/2026
Glades Formulating Group Leaking Drums Joseph De Luna
909 NW 13th St 561-681-6767
Belle Glade Palm Beach 954-658-8020
12 drums
10,000
LE 809 3704 0100 000 FC 131545 099001 101492 10,000 00
Joseph De Luna 3/24/2026
Jon Hines 03/24/2026
Vickie Koenig 3/26/2026
Samuel Graves
✔ ✔9
Vickie Koenig Digitally signed by Vickie Koenig Date: 2026.03.26 11:21:04 -04'00'
Jon Hines Digitally signed by Jon Hines Date: 2026.03.25 11:34:33 -04'00'
Joseph De Luna Emergency Responder
Digitally signed by Joseph De Luna Emergency Responder Date: 2026.03.24 16:58:05 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2026.04.16 12:40:13 -04'00'
File details come from the government source that posted it. Updated .