CN-370000-LE811-4I-73611.pdf
PDF 161 KB Posted
- Contract number
- LE811
- Issued by
- Florida
About this file
Work Authorization Summary
This is a Work Authorization Form (OER_13) issued by the Florida Department of Environmental Protection (FDEP), Office of Emergency Response, authorizing emergency response work under an indefinite delivery vehicle contract. The contractor is Cliff Berry Inc. (CBI), operating under Contract #LE811. The work is authorized by DEP Representative Jon Belcher and approved by OER Budget Representative Samuel Graves, with contractor representative Aiden Tellier executing on behalf of CBI. The incident response is located at Myrtle and Duff Road in Lakeland, Polk County, Florida, with a GPS coordinate reference of 28.129620, -81.994252. The incident occurred on March 18, 2026, and the authorization was executed on March 19, 2026.
The authorized work consists of spill response and soil removal services at the specified location, with the primary task being the scraping, containerization, and removal of impacted soil measuring approximately 20 feet by 6 feet by 2 inches in depth, estimated at approximately 4 fifty-five-gallon drums of material. The work assignment is structured as a fixed-price contract with a not-to-exceed estimate amount of $2,500.00. Funding is allocated from Project LE 811, Organization Code 3704 0100 000, Object Code 131545, Fund Category 099001, and Category/Year 101492. The authorized level of effort includes one supervisor and one recovery technician, with equipment specified including a response truck and four 55-gallon drums, with PPE Level D required for personnel. The work is subject to oversight by the DEP Contract Manager to ensure compliance with documentation and timeliness requirements.
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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) 2026-4I-73611
LE811 Aiden Tellier 3/18/26
Myrtle and Duff Rd Jon Belcher
28.129620, -81.994252 813-470-5908
Lakeland Polk 813-399-0581
Impacted soil, 20'x6'x2"
D
Impacted soil will need to be scraped, containerized and taken for disposal. Estimated volume of soil is ~4 55gal drums.
LE 811 3704 0100 000 FC 131545 099001 101492 2,500 00
Aiden Tellier 3/19/2026
Vickie Koenig 3/19/2026
Samuel Graves
Vickie Koenig Digitally signed by Vickie Koenig Date: 2026.03.19 12:15:30 -04'00'
Aiden Tellier Digitally signed by Aiden Tellier Date: 2026.03.19 11:35:33 -04'00'
Jon Belcher Digitally signed by Jon Belcher Date: 2026.03.19 11:58:31 -04'00'
Samuel Graves Digitally signed by Samuel Graves Date: 2026.03.31 13:43:44 -04'00'
File details come from the government source that posted it. Updated .