CN-370000-LE811-1C-71087.pdf
PDF 160 KB Posted
- Contract number
- LE811
- 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. The document authorizes work under an indefinite delivery contract between the State of Florida and Cliff Berry Inc., identified by Contract Number LE811 and DEP Incident Number 2024-1C-71087. The incident, dated April 29, 2024, is located at Black Creek North of Knight Marina in Green Cove Springs, Clay County, Florida. The On-Scene Coordinator is Brierra T. Mack, with incident response oversight and approvals from representatives of the contractor, DEP, and the OER Budget Representative.
The work authorization calls for the immediate response and recovery of one 55-gallon polyethylene drum filled with over-the-road diesel from the Black Creek site. The scope requires specialized equipment, specifically a boat capable of recovering the full drum, which is reported to be in good condition. The level of effort includes one supervisor and two recovery technicians, along with a response truck and straight truck. The work is assigned as a fixed-price contract with a not-to-exceed amount of $1,500.00. Analytical and disposal arrangements are designated to be handled via the contractor. Funding for this work is provided through Project Number LE 811, Organization Code 3704 0100 000, with the total authorized amount of $1,500.00 charged to Fund Category 102577 (FC 131545). The work authorization was executed and approved on May 1-2, 2024.
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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 2024-1C-71087
LE811 Y. Cerna 4/29/2024
Black Creek- North of Knight Marina Brierra T. Mack
30.0622345, -81.7297498 904-256-1679
Green Cove Springs Clay 904-673-5357
55-gallon poly drum filled with over the road diesel
Need boat that is able to recover (1) full 55-gallon poly drum. The drum appears to be in good condition.
LE 811 3704 0100 000 FC 131545 0990001 102577 1,500 00
Brierra T. Mack 5/1/2024
Vickie Koenig 5/2/2024
Samuel Graves
✔ 1
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.05.02 12:04:40 -04'00'
Yvonne Cerna Digitally signed by Yvonne Cerna Date: 2024.05.01 12:02:28 -04'00'
Brierra Mack Digitally signed by Brierra Mack Date: 2024.05.01 10:46:24 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.05.02 16:47:58 -04'00'
File details come from the government source that posted it. Updated .