CN-370000-LE811-2I-69001.pdf
PDF 130 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's Office of Emergency Response. The document authorizes work under contract LE811 with CBI and involves DEP Incident #2022-21-69001Z dated 5/11/2022. The incident location is 1151 North Federal Highway, Boca Raton, Palm Beach County, Florida. The OSC (On-Scene Coordinator) is MacKay Eyster, with contact numbers 561-681-6767 (office) and 954-658-8020 (cell). The work authorization was executed with signatures from DEP Representative MacKay Eyster (5/12/2022), Contractor Representative William Reasoner (10/28/2022), and OER Budget Representative Amanda Lanphere (01/13/2022), with final approval from Samuel Graves (11/02/2022).
The work scope includes overpack drums as the primary task and requires personnel (1 Supervisor and 1 Recovery Technician identified as "Driver") and equipment including a response truck and overpack drums with Visqueen. The analytical and disposal arrangements are to be handled via the contractor. The work is authorized as a fixed-price assignment with a not-to-exceed estimate amount of $1,500.00. Funding is allocated through Project No. LE 811, Organization Code 37040100000, Object Code 099001, Fund Category/Year 131545/12577, with the $1,500.00 amount sourced from the specified funding line. The contract rate specified is $1,500.00.
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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
CBI 2022-2I-69001Z
LE811 Bill Reasoner 5/11/22
MacKay Eyster
1151 North Federal Highway 561-681-6767
Boca Raton Palm Beach County 954-658-8020
Driver
1500.00
LE 811 37040100000 FC 099001 131545 12577 1500 00
Mackay Eyster 5/12/22
William Reasoner 10/28/2022
Amanda Lanphere 01/13/2022
Samuel Graves
Amanda Lanphere Digitally signed by Amanda Lanphere Date: 2023.01.13 13:50:04 -05'00'
William Reasoner Digitally signed by William Reasoner Date: 2022.10.28 09:36:00 -04'00'
Mackay Digitally signed by Mackay Date: 2022.05.12 09:57:37 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2022.11.02 13:45:45 -04'00'
File details come from the government source that posted it. Updated .