CN-370000-LE811-4C-70807.pdf
PDF 157 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 form authorizes work to be performed by Cliff Berry Inc. (CBI) under Contract LE811 for DEP Incident #2024-4C-70807, dated January 29, 2024. The incident response is located at 4460 Bahama Road in Hernando Beach, Hernando County, Florida. The On-Scene Coordinator is Jasson Drinkard, and the form has been approved by DEP Representative Jasson Drinkard, Contractor Representative Jon Sandora, and OER Budget Representative Vickie Koenig.
The work authorization covers an abandoned drum response requiring immediate action, with a fixed-price assignment of $1,450. The scope of work includes one supervisor and one recovery technician, utilizing a response truck and PPE Level D equipment. Analytical and disposal arrangements are handled via the contractor. Funding is charged to Project No. LE811, Organization Code 3704 0100 000, Object Code 131545, Fund Category/Year 102577, with an allocated amount of $1,450.00. The authorization was executed on January 30, 2024, and is subject to review and evaluation by the DEP Contract Manager to ensure appropriate documentation and timely submission.
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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 (CBI) 2024-4C-70807
LE811 Jon Sandora 1/29/2024
4460 Bahama Rd Jasson Drinkard
4460 Bahama Rd 813-470-5908
Hernando Beach Hernando 813-244-2934
D
1.450
LE811 3704 0100 000 FC 131545 0990001 102577 1,450 00
Jasson Drinkard 1/29/24
Vickie Koenig January 30, 2024
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.01.30 10:37:42 -05'00'
Jon Sandora Digitally signed by Jon Sandora Date: 2024.01.30 10:20:35 -05'00'
Jasson Drinkard Digitally signed by Jasson Drinkard Date: 2024.01.30 08:17:12 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.01.30 10:28:16 -05'00'
File details come from the government source that posted it. Updated .