CN-370000-LE811-2C-69171.pdf
PDF 130 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's Office of Emergency Response. The document authorizes work performed by Cliff Berry Inc under Contract LE811 for incident 2022-2C-6917Z occurring on July 2, 2022, at Hillsboro Beach in Broward County, Florida. The work was authorized by DEP Representative Mackay Eyster, Contractor Representative Jon Hines, and OER Budget Representative Amanda Lanphere, with final approval from Samuel Graves.
The authorization covers emergency response services for overpack drums and abandoned drum removal at the Hillsboro Beach site. The contracted work involves one driver as personnel and one response truck as the primary vehicle and equipment. The work assignment is structured as a fixed price with a not-to-exceed estimate amount of $2,500. Analytical and disposal arrangements are handled via the contractor. Funding is allocated from Project LE811 under Organization Code 37040100000, with Object Code 139900, Fund Category 099001, and funds sourced from Category/Year 102577. The total authorized amount is $2,500.00. All required signatures were executed digitally, with contractor authorization on July 5, 2022, and final budget approval on July 25, 2022.
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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 Bery Inc 2022-2C-69171Z
LE811 Jon Hines 7/2/22
Hillsboro Beach Mackay Eyster
1069 Hillsboro Mile 561-681-6767
Hillsboro Beach Broward 954-658-8020
Driver
2,500
LE811 37040100000 FC 139900 099001 102577 2500 00
Mackay Eyster 7/2/22
Jon Hines 07/05/22
Amanda Lanphere 07/25/2022
Samuel Graves
✔ ✔ (1) cylinder
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.07.25 13:45:52 -04'00'
Jon Hines Digitally signed by Jon Hines Date: 2022.07.05 11:18:58 -04'00'
Mackay Eyster Digitally signed by Mackay Eyster Date: 2022.07.02 13:25:11 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.07.05 11:28:03 -04'00'
File details come from the government source that posted it. Updated .