CN-370000-LE809-3I-70773.pdf
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- 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, dated February 20, 2024. The form authorizes work under Contract LE809 with contractor CBI for emergency response services related to a diesel spill incident at Monroe US 1 in Cross Key, Monroe County, Florida. The incident, identified as DEP Incident #2024-3I-70773, occurred on January 18, 2024, and the authorized work was initiated under the direction of On-Scene Coordinator (OSC) Joseph Deluna.
The work authorization covers spill response and soil removal services with an approved fixed-price amount of $13,200. The scope of work includes mobilization of personnel (one supervisor, one recovery technician, and one field chemist), equipment deployment (dump truck, tractor-trailer, and OVA vapor detector), and sampling gear with EPA Level 1 certification and specified PPE. Funding is drawn from Project LE 809 under FDEP organization code 3704 0100 000, with the work classified under object code 131545 and fund category FC 0990001 for fiscal year 101492. The form was executed with digital signatures from Joseph Deluna (DEP Representative), Robert C. Summers, P.G. (Contractor Representative), and Vickie Koenig (OER Budget Representative) on February 9, 15, and 20, 2024, respectively.
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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
CBI 2024-3I-70773
LE809 Robert Summers 1/18/2024
Monroe US 1 Diesel Spill Joseph Deluna
25.22028° N, 80.42892° W 561-681-6767
Cross Key Monroe 954-658-8020
Dump Truck , Tractor railer, OVA
13,200
LE 809 3704 0100 000 FC 131545 0990001 101492 $13,200 00
Joseph Deluna 2/09/2024
Robert C. Summers, P.G. 2/15/24
Vickie Koenig 2/20/2024
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.02.20 12:13:11 -05'00'
Robert C. Summers, Jr., P.G.
Digitally signed by Robert C. Summers, Jr., P.G.
Date: 2024.02.15 09:17:00 -05'00'
Joseph Deluna Digitally signed by Joseph Deluna Date: 2024.02.09 15:23:41 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.02.20 11:51:59 -05'00'
File details come from the government source that posted it. Updated .