CN-370000-LE809-4I-69023.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, authorizing emergency spill response services from contractor Cliff Berry Inc. under contract 2022-4I-69023. The authorization was issued on September 23, 2022, for an incident at 7019 Clearview Avenue in Tampa, Hillsborough County, with Sean Lynch designated as the On-Scene Coordinator and Jon Sandora serving as the contractor's representative.
The work scope involves immediate spill response and soil removal for approximately 20-30 gallons of spilled used oil in a ditch. The authorization covers personnel (supervisor, recovery technician, and equipment operator), vehicles (backhoe or similar equipment), and equipment (roll-off containers). The work is assigned as a fixed-price authorization with a not-to-exceed amount of $5,425 and a material limit of 10 tons. Analytical and disposal arrangements will be handled via the contractor. Funding is allocated from Project No. LE 809 with organizational code 37040100000, object code 139900, fund category 099001, and category/year 101492. The Work Authorization Form was executed and digitally signed by all required parties on September 26, 2022, including the DEP Representative (Sean Lynch), Contractor Representative (Jon Sandora), and OER Budget Representative (Amanda Lanphere).
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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 2022-4I-69023
LE 809 Jon Sandora 09/23/2022
Clearview Ave Soil Removal Sean Lynch
7019 Clearview Ave 813-470-5925
Tampa Hillsborough 813-244-2934
20-30 gallons of spilled used oil in ditch.
Not to exceed 5,425 and/or 10 tons of material
LE 809 37040100000 FC 139900 099001 101492 5425 00
Sean Lynch 9/26/2022
Jon Sandora 9/26/2022
Amanda Lanphere 09/26/2022
Samuel Graves
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.09.26 15:17:02 -04'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2022.09.26 09:11:44 -04'00'
Sean Lynch Digitally signed by Sean Lynch Date: 2022.09.26 08:10:20 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.09.26 12:05:28 -04'00'
File details come from the government source that posted it. Updated .