CN-370000-LE811-4C-72455.pdf
PDF 160 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 (OER), dated March 20, 2025. The form authorizes work under contract 2025-4C-72455 with Cliff Berry Inc (CBI), with representation by Aiden Tellier. The incident, designated as DEP Incident #2025-4C-72455, occurred on March 20, 2025, at Old Highway 41-A in Tampa, Hillsborough County, Florida. The On-Scene Coordinator is Jasson Drinkard, with primary contact phone 813-470-5908 and cell 813-244-2934.
The authorized work involves response to abandoned drums containing used motor oil at the incident site. The work scope includes one supervisor and one recovery technician, utilizing a response truck and PPE Level D equipment. The work is assigned as a fixed-price contract with a not-to-exceed amount of $1,600.00. Analytical and disposal arrangements are handled via the contractor. Funding is sourced from Project LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund 099001, Category/Year 102577, with the total amount of $1,600.00. The form was executed with digital signatures from all required parties: DEP Representative Jasson Drinkard (March 20, 2025), Contractor Representative Aiden Tellier, and OER Budget Representative Vickie Koenig (May 5, 2025).
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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) 2025-4C-72455
LE811 Aiden Tellier 03-20-25
Old Hwy 41-A Jasson Drinkard
Old Hwy 41-A 813-470-5908
Tampa Hillsborough 813-244-2934
Used Motor Oil
D
1600.00
LE 811 3704 0100 000 FL 131545 099001 102577 1,600 00
Jasson Drinkard 03-20-2025
Aiden Tellier
Vickie Koenig 05/05/2025
Samuel Graves
✔ 2
Vickie Koenig Digitally signed by Vickie Koenig Date: 2025.05.05 20:01:11 -04'00'
Aiden Tellier Digitally signed by Aiden Tellier Date: 2025.03.21 14:45:57 -04'00'
Jasson Drinkard Digitally signed by Jasson Drinkard Date: 2025.03.20 15:35:55 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2025.05.06 10:12:07 -04'00'
File details come from the government source that posted it. Updated .