CN-370000-LE811-1I-73424.pdf
PDF 163 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 (FDEP), Office of Emergency Response, authorizing work under Contract LE811 with Cliff Berry, Inc. The form documents emergency response activities at the I-295 SB & I-10 WB interchange in Jacksonville, Duval County, Florida, for DEP Incident #2026-11-73424 dated January 7, 2026. The On-Scene Coordinator is Donielle McKinley, and the authorization has been executed by representatives from FDEP, the contractor, and the budget office.
The work authorization covers the transport of drums to a Treatment, Storage, and Disposal Facility (TSDF) and removal of an abandoned drum containing approximately 55 gallons of poly drum waste oil. The work is assigned as a fixed-price contract with a not-to-exceed amount of $2,500.00. Funding is provided from FDEP budget line LE 811 under Project No. 3704 0100 000, Organization Code FL 131545, Object Code 099001, and Fund Category/Year 102577. All required signatures from the DEP Representative, Contractor Representative, and OER Budget Representative were obtained between January 7 and January 9, 2026, with final approval by Samuel Graves on March 9, 2026.
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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 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'
File details come from the government source that posted it. Updated .