CN-370000-LE809-4I-70913.pdf
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- Contract number
- LE809
- Issued by
- Florida
About this file
Work Authorization Summary
This is a Work Authorization Form (WAF) issued by the Florida Department of Environmental Protection (FDEP) Office of Emergency Response. The document authorizes work under contract LE809 with Cliff Berry Inc. (CBI), a contractor located at 5020 St Paul Street in Tampa, Hillsborough County, Florida. The incident, numbered 2024-4I-70913, was initiated on February 27, 2024, with Jon Belcher serving as the On-Scene Coordinator.
The authorization covers spill response and soil removal services involving an estimated 50–60 gallons of used motor oil, contaminated soil, and one tote. The scope of work includes deploying one supervisor and two recovery technicians, utilizing a vacuum truck and six 55-gallon drums for containment. The work is assigned as a fixed-price task with a not-to-exceed estimate of $3,000. Funding is allocated from Project LE809, Organization Code 3704 0100 000, with Object Code 131545 and Fund Category 0990001 (101492). The authorization was executed on February 27–28, 2024, with signatures from DEP Representative Jon Belcher, Contractor Representative Jon Sandora, and OER Budget Representative Vickie Koenig.
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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 (CBI) 2024-4I-70913
LE809 Jon Sandora 2/27/24
5020 St Paul St Jon Belcher
5020 St Paul St 813-470-5908
Tampa Hillsborough 813-399-0581
50-60 gallons used motor oil; contaminated soil; (1) tote
Amount of drums is estimated.
LE809 3704 0100 000 FC 131545 0990001 101492 3,000 00
2/27/24
Vickie Koenig 2/28/2024
Samuel Graves
✔ ✔ 6
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.02.28 10:37:12 -05'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2024.02.27 16:16:46 -05'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2024.02.27 15:57:28 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.02.28 09:23:57 -05'00'
File details come from the government source that posted it. Updated .