CN-370000-LE811-4I-71819.pdf
PDF 159 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
This Work Authorization Form (OER_13) is issued by the Florida Department of Environmental Protection's Office of Emergency Response authorizing work under an indefinite delivery contract with Cliff Berry Inc (CBI). The authorization is associated with DEP Incident #2024-4I-71819C dated December 5, 2024, and references Contract #LE811. The work site is located at 11727 N 12th Street in Tampa, Hillsborough County, Florida. The On-Scene Coordinator (OSC) is Jasson Drinkard, who can be reached at 813-470-5908 (office) or 813-244-2934 (cell).
The work involves response to three abandoned drums containing used motor oil. The level of effort includes deployment of a supervisor and recovery technician, along with a response truck. Analytical and disposal arrangements will be managed via the contractor. The work assignment is structured as a fixed-price engagement with a not-to-exceed estimate of $2,000.00. Funding is provided through Project No. LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund Category/Year 102577, with an authorized amount of $2,000.00. The authorization was executed on December 5, 2024, with final budget approval signed on December 16, 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 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) 2024-4I-71819C
LE811 12/5/2024
N. 12th St Jasson Drinkard
11727 N 12th St Tampa 813-470-5908
Tampa Hillsborough 813-244-2934
Used Motor Oil
D
2000.00
LE 811 3704 0100 000 FL 131545 099001 102577 2,000 00
Jasson Drinkard 12/5/2024
Aiden Tellier
Vickie Koenig 12/16/2024
Samuel Graves
✔ 3
Vickie Koenig Digitally signed by Vickie Koenig Date: 2024.12.16 11:25:32 -05'00'
Aiden Tellier Digitally signed by Aiden Tellier Date: 2024.12.10 07:32:16 -05'00'
Jasson Drinkard Digitally signed by Jasson Drinkard Date: 2024.12.05 09:59:12 -05'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2024.12.16 11:22:40 -05'00'
File details come from the government source that posted it. Updated .