CN-370000-LE811-1I-73424.pdf
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- Contract number
- BDA73
- Issued by
- Florida
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Work Authorization Form Summary
This is a Work Authorization Form (OER_13, effective 7-01-2017) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response (OER), for emergency response services. The document authorizes work to be performed by Cliff Berry, Inc. under Contract No. LE811 at the intersection of I-295 SB and I-10 WB in Jacksonville, Duval County, Florida. The incident reference is 2026-11-73424, dated 1-7-2026, with Donielle McKinley designated as the On-Scene Coordinator.
The authorized work involves the transportation of drums to a Treatment, Storage, and Disposal Facility (TSDF) and addresses an abandoned 55-gallon poly drum approximately half full of waste oil. The work is assigned as a fixed-price contract with a not-to-exceed amount of $2,500.00. Funding is allocated from Project No. LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund 099001, Category/Year 102577. The work authorization was approved and executed with digital signatures from DEP Representative Donielle McKinley (1-7-2026), Contractor Representative Yvonne Cerna (01-08-2025), OER Budget Representative Vickie Koenig (1-9-2026), and Samuel Graves (03-09-2026).
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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 2026-1I-73424
LE811 1-7-2026
I-295 SB & I-10 WB Donielle McKinley
I-295 SB & I-10 WB 904-256-1552
Jacksonville Duval 904-510-2643
1 55-gallon poly drum approximately half full of waste oil
2500.00
LE 811 3704 0100 000 FL 131545 099001 102577 $2,500 00
Donielle McKinley 1-7-2026
YVONNE CERNA 01/08/2025
Vickie Koenig 1/9/2026
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2026.01.09 08:49:04 -05'00'
Yvonne Cerna Digitally signed by Yvonne Cerna Date: 2026.01.08 14:27:29 -05'00'
Donielle McKinley Digitally signed by Donielle McKinley Date: 2026.01.07 14:56:23 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2026.03.09 14:49:18 -04'00'
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