CN-370000-LE810-BCE2023S.pdf

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: __________________

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 Services, Inc. BCE2023

LE810 Larry Hall NA

Blackjack Creek Oil and Gas Wellfield (Blackjack Creek) Gerald Walker southeast of Jay, Florida : (850) 524-8405

Jay Santa Rosa (850) 524-1468 see Scope of Services, attached

H2S monitoring, oil and gas field related monitoring, and containment of pollutants/contaminates.

Contractor to provide essential site environmental and safety monitoring services for the Blackjack Creek Field facilities, as described and agreed in attached Scope of Services.

In accordance with paragraph 2.C. of the contract, at least monthly invoicing will be allowed as described under the Scope of Services based on the anticipated time to complete these services.

50,000

37357030000 ZJ 139900 780001 088502/20 50,000

Gerald Walker 12/21/23

Larry Hall 12/22/23

Avery Lehmann

Cindy Mulkey see Scope of Services, attached

Digitally signed by Avery Lehmann Date: 2023.12.22 10:44:19 -05'00'

Larry Hall Digitally signed by Larry Hall Date: 2023.12.22 09:54:20 -05'00'

Cindy Mulkey Digitally signed by Cindy Mulkey Date: 2023.12.22 10:52:40 -05'00'

Gerald Walker Digitally signed by Gerald Walker Date: 2023.12.21 17:08:05 -05'00'

Scope of Services Supplemental WAF Support Services for Blackjack Creek Field

DEPARTMENT OF ENVIRONMENTAL PROTECTION

SCOPE OF SERVICES – SUPPORT SERVICES FOR BLACKJACK CREEK FIELD

NECESSARY CONSUMABLES, SUPPLIES AND SAFETY EQUIPMENT

SUMMARY

Contractor shall provide services to secure and provide qualified labor for continuation of essential site environmental and safety monitoring services at the Blackjack Creek Treatment (Separation) Plant and the associated Blackjack Creek Oil and Gas Wellfield (collectively, the “Blackjack Creek Field”) located southeast of Jay, Florida. Such services shall provide essential site environmental and safety monitoring activities for the Blackjack Creek Field facilities in preparation for potential plant decommissioning, and for field well plugging and abandoning activities to be performed by a separate Department contractor. Contractor shall also provide labor at the Blackjack Creek Field to assist with evaluation, containment, and removal of any pollutant at the site.

This Scope of Services is a supplement to the Work Authorization Form (WAF) executed on December 8, 2023.

Task 2 Provide Ongoing Minimum Labor/Staffing Requirements, Deliverable No. 7, of the December 8, 2023, WAF requires Contract[or] to obtain a written Supplemental Work Authorization for any consumables or supplies determined to be necessary in the performance of Task 2. The Supplemental WAF associated with this Scope of Work, is being executed as a fulfillment of that requirement.

Contractor agrees that services under this Scope of Services will not begin until issuance of the Supplemental WAF under State Contract LE810, and the subsequent receipt of a written notification from the Department Contract Manager, or from one of the below identified Department Contacts for this Scope of Services, that the Contractor may begin to provide services under this Scope of Services.

The Department’s contact persons for this Scope of Services shall be:

Gerald Walker, Oil & Gas Administrator Phone: (850) 524-8405 Email: Gerald.a.Walker@FloridaDEP.gov

Cindy Mulkey, Deputy Director, Division of Water Resource Management Phone: (850) 688-7596 Email: Cindy.Mulkey@dep.state.fl.us

John Coates, Director, Division of Water Resource Management Phone: (850) 245-8709 Email: John.Coates@FloridaDEP.gov

The Department’s Project Manager for this Scope of Services shall be:

Marty Lee, Environmental Specialist Phone: (850) 675-6558 Email: Marty.M.Lee@FloridaDEP.gov

SECTION 1, TASKS:

Task 3. Necessary Consumables and Supplies for Task 2

In continued support of services to secure essential site environmental and safety monitoring services at the Blackjack Creek Treatment (Separation) Plant, the Contractor will identify and provide consumables and/or supplies determined necessary for the performance of Task 2 – “Provide Minimum Labor/Staffing Requirements” starting on

Scope of Services Supplemental WAF Support Services for Blackjack Creek Field the day of the execution of this Supplemental Work Authorization. The consumables and supplies included in this task may include, but are not limited to, the following:

paper products, cleaning supplies, potable water, and Office supplies.

The items purchased under this Task are to be consumable and non-permanent use equipment or instruments.

Task 3. Deliverables

Contractor shall provide the following:

1. Contractor completed Daily Report Forms describing the purchases in the “Remarks Box” and including attached original or copies of purchase receipts. Please note that any taxes incurred by the Contractor will not be reimbursed by the Department..

Task 4. Equipment Restoration and Maintenance for Task 2

Contractor will identify support and/or safety equipment necessary to secure and provide essential site environmental and safety monitoring services at the Blackjack Creek Field and submit a written recommendation to the Department. The Contractor shall not implement any recommended purchases without written approval from the Department. Items that may be identified for this task could include, but are not limited to, the following:

Fire extinguisher upgrades/maintenance, SSV/Actuators H2S sensors, Well safety valves; and Other safety related equipment upgrades/equipment.

Task 4. Deliverables

Contractor shall include written pre-approval of purchased items with completed Daily Report Forms describing the purchases in the “Remarks Box” and including attached original or copies of purchase receipts.

SECTION 2, PAYMENT PROVISIONS

1. Deliverables will be reviewed by the Department to confirm they are complete, accurate, and timely.

2. Please note that any taxes incurred by the Contractor will not be reimbursed by the Department.

3. Contractor shall bill the Department on at least a monthly basis for services provided under Task 1, Task 2, Task 3, and Task 4, and may bill the Department for services provided under Task 1 and Task 2 after each 14 day period at the Contractor’s sole discretion.