CN-370000-LE809-3C-69543.pdf
PDF 139 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 (FDEP), Office of Emergency Response (OER). The form authorizes work to be performed by Cliff Berry, Inc. under Contract #LE809 in response to a spill incident (DEP Incident #2022-3C-69543) occurring on October 8, 2010, at the SW 51st Terrace Canal in Cape Coral, Lee County, Florida. The incident involved fuel contamination on a waterbody, with OSC (On-Scene Coordinator) responsibilities assigned to Gracie Kennedy and Nathaniel Harvey. The form was executed on October 10, 2022, with digital signatures from multiple authorized representatives including DEP Representative Gracie Kennedy, Contractor Rep Kelly Brandenburg, and OER Budget Rep Amanda Lanphere.
The work authorization specifies a spill response requiring immediate action with a fixed-price work assignment not to exceed $5,000. The scope includes pressure washing of bulkheads and removal of oily debris (including booms, pads, palm fronds, and coconuts) from the canal. The level of effort includes one supervisor, one recovery technician, and one equipment operator utilizing a straight truck, vacuum truck, and portable pressure washer. Suspected materials are classified as oily wastewater. Funding is allocated from Project No. LE809, Organization Code 37040100000, Object Code 139900, Fund Category 099001, under budget category 101492 for the fiscal year. The contractor is authorized to transport drums to a Treatment, Storage, and Disposal Facility (TSDF) and profile wastes as oily wastewater for proper disposal.
View the file
Other files
Show all 26
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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. 2022-3C-69543 (FD091)
LE809 Jon Hines 10/8/10
SW 51st Terrace Canal Gracie Kennedy/ Nathaniel Harvey
Canal at 1127 SW 51st Terrace 904-256-1528
Cape Coral Lee 904-2376261 /904-237-6276
10/10/22 timeTBD
Fuel on waterbody of canal may require pressure washing of bulkheads and debris ( oily boom and pads, palm frons and coconuts)removal
1 Level D/Work Clothes portable pressure washer
$5,000
LE809 37040100000 FC 139900 099001 101492 $5,000 00
Gracie Kennedy 10/10/22
Kelly Brandenburg 10/10/22
Amanda Lanphere 10/10/2022
Samuel Graves
Oily wastewater
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.10.10 18:51:59 -04'00'
Kelly Brandenburg Digitally signed by Kelly Brandenburg Date: 2022.10.10 11:57:18 -04'00'
Digitally signed by Gracie Kennedy Date: 2022.10.10 11:17:04 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.10.10 12:07:06 -04'00'
File details come from the government source that posted it. Updated .