CN-370000-LE811-4C71652Z.pdf
PDF 200 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), authorizing emergency response work under an existing contract with Cliff Berry Inc (CBI). The form documents authorization for work at the Hudson location in Pasco County, Florida, related to DEP Incident #2024-4C716522, dated October 21, 2024. The incident is managed by OSC Jasson Drinkard. Key personnel involved include Aiden Tellier as the contractor representative and Samuel Graves as the DEP representative.
The work authorization covers removal of an abandoned 55-gallon drum containing approximately 3/4 full of PCW material. The level of effort includes one supervisor and one recovery technician, a response truck, and standard response equipment. Analytical and disposal arrangements will be handled via the contractor. The work is authorized on a fixed-price basis with a not-to-exceed amount of $1,400.00. Funding is allocated from Project LE 811, Organization Code 3704 0100 000, with EO code FC, Object Code 131545, Fund 099001, and Category/Year 102577. The authorization was executed on October 21, 2024, with approvals from the DEP representative, contractor representative, and OER budget representative (Vickie Koenig) on October 28, 2024.
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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
Contractor: ____________________________________ Contract #: ___________ Rep: ____________________ Site Name: ____________________________________ Location: ______________________________________ City: __________________County: _________________
Supplemental WAF
DEP Incident # ___________(FD097)___________ Incident Date _______________________
OSC: ______________________________
Phone: Office______________________
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
File details come from the government source that posted it. Updated .