CN-370000-LE811-1I-73291.pdf
PDF 158 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
Work Authorization Form Summary
This is a Work Authorization Form (OER_13, effective July 1, 2017) issued by the Florida Department of Environmental Protection's Office of Emergency Response. The document authorizes emergency response work under Contract LE811 between the Department and Cliff Berry Inc., a contractor based in Jacksonville, Florida. The work was authorized on November 14, 2025, in response to an abandoned drum incident (DEP Incident #2025-11-73291) located at 5000 Ortega Farms Boulevard in Duval County.
The work authorization covers the removal and proper handling of 55 gallons of used motor oil contained in a blue poly drum classified as an abandoned drum. The assignment is structured as fixed-price work with a not-to-exceed amount of $2,500. The contractor will conduct the disposal arrangement via contractor services. Funding is allocated from Project LE811 with an organization code of 3704 0100 000, object code 131545, fund category 099001, and category year 102577. All required approvals were obtained from the DEP Representative (Donielle McKinley), the Contractor Representative (Yvonne Cerna), and the OER Budget Representative (Vickie Koenig) between November 14 and November 18, 2025.
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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. 2025-1I-73291
LE811 11/14/2025
5000 Ortega Farms Blvd. Donielle McKinley
5000 Ortega Farms Blvd. 904-256-1551
Jacksonville Duval 904-510-2643
55 gallons used motor oil in blue poly drum.
LE811 3704 0100 000 FL 131545 099001 102577 2,500 00
Donielle McKinley 11/14/2025
11/14/2025
Vickie Koenig 11/18/2025
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.11.18 12:57:50 -05'00'
Yvonne Cerna Digitally signed by Yvonne Cerna Date: 2025.11.14 13:42:53 -05'00'
Donielle McKinley Digitally signed by Donielle McKinley Date: 2025.11.14 10:42:58 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.11.18 12:55:26 -05'00'
File details come from the government source that posted it. Updated .