CN-370000-LE811-2C-69710.pdf
PDF 159 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
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), authorizing work under contract with Cliff Berry, Inc. The authorization was executed on December 20-22, 2022, for incident number 2022-2C-69710 at No Name Harbor in Key Biscayne, Miami-Dade County. The incident involved the discovery of eight (8) five-to-ten gallon jugs containing petroleum products. Key personnel include OSC Camren Richter, DEP Representative Camren Richter, Contractor Representative Steve Swett, and OER Budget Representative Amanda Lanphere.
The work authorization is issued as a fixed-price contract with a not-to-exceed estimate amount of $2,000. The scope of work is classified as an abandoned drum response requiring immediate action. The level of effort includes two recovery technicians and one response truck equipped with overpack drums. Analytical and disposal arrangements are to be handled via the contractor. Funding is allocated from Project Number LE811 under Organization Code 37040100000 with Object Code 131545, Fund Category 099001, and Category/Year 102577, with a total authorized amount of $2,000.00.
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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. 2022-2C-69710
LE811 Steve Swett 12/20/22
No Name Harbor Camren Richter
1200 Crandon Blvd 561-681-6767
Key Biscayne Miami Dade 954-658-4506
Eight (8) 5-10 gallon jugs containing petroleum products
LE811 37040100000 FC 131545 099001 102577 2000 00
Camren Richter 12/20/2022
Steve Swett 12-21-22
Amanda Lanphere 12-22-2022
Samuel Graves
✔ 1
✔ See below.
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2022.12.22 12:08:36 -05'00'
Steve Swett Digitally signed by Steve Swett Date: 2022.12.21 13:45:56 -05'00'
Camren Richter Digitally signed by Camren Richter Date: 2022.12.20 11:09:26 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.12.22 10:17:52 -05'00'
File details come from the government source that posted it. Updated .