CN-370000-LE810-4C-72435.pdf
PDF 160 KB Posted
- Contract number
- LE810
- Issued by
- Florida
About this file
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection, Office of Emergency Response, authorizing work by Hulls Environmental under Contract LE810. The authorization is for incident 2025-4C-72435 dated February 16, 2025, at the Ozello Trail site in Crystal River, Citrus County, Florida. The work is managed by On-Scene Coordinator Jon Belcher and supervised by DEP Representative Jon Belcher, with Michael Bevacqua serving as the Contractor Representative and Vickie Koenig as the OER Budget Representative.
The work authorization covers spill response activities involving the removal of diesel-impacted debris from two drums at the incident site. The scope of work includes two recovery technicians, two 55-gallon drums, and PPE Level D equipment. The work is assigned as a fixed-price contract with a not-to-exceed estimate of $2,000. Funding is allocated from Project LE 810 under Organization Code 3704 0100 000, with Object Code 131545, Fund Category 099001, and Category/Year 101492. The authorization was executed on March 19, 2025, with digital signatures from all required parties approving the work scope, budget allocation, and project documentation requirements.
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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
Hulls Environmental 2025-4C-72435
LE810 Jason Malluck 2/16/25
Ozello Trail Jon Belcher
12681 Ozello Trail 813-470-5908
Crystal River Citrus 813-399-0581
Diesel Impacted Material (2) drums
D
Remove diesel impacted debris
2,000
LE 810 3704 0100 000 FC 131545 099001 101492 2,000 00
Jon Belcher
Michael Bevacqua 3/19/2025
Vickie Koenig 3/19/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.03.19 11:39:22 -04'00'
Michael Digitally signed by Michael Date: 2025.03.19 10:16:25 -04'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2025.03.17 08:38:14 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.03.19 11:14:50 -04'00'
File details come from the government source that posted it. Updated .