"Petroleum Restoration Program Cost Share Site Contractor Recommendation Sheet" - Florida

Petroleum Restoration Program Cost Share Site Contractor Recommendation Sheet is a legal document that was released by the Florida Department of Environmental Protection - a government authority operating within Florida.

Form Details:

  • Released on July 12, 2017;
  • The latest edition currently provided by the Florida Department of Environmental Protection;
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PETROLEUM RESTORATION PROGRAM
COST SHARE SITE CONTRACTOR RECOMMENDATION SHEET
The Responsible Party (RP) may use this sheet to recommend an Agency Term Contractor with a contract in the same region
as the site to perform work pursuant to a cost-share agreement in the Petroleum Restoration Program (PRP) that meets the
25% or higher cost share requirement pursuant to Chapter 62-772, Florida Administrative Code, Procurement Procedures
for the Petroleum Restoration Program. The entity selecting the Contractor must be a party to the executed cost share
agreement.
Site Name: ___________________________________________________ FDEP Facility ID#: ___________________
Site Address: __________________________________________________ Parcel ID#: __________________________
Responsible Party Name: _____________________________________________________________________________
Responsible Party Rep. Name & Title: __________________________________________________________________
Responsible Party Rep. Phone # & E-mail: _______________________________________________________________
Select only one of the contractor options listed below:
Recommend a PRP Agency Term Contractor with a valid contract in the region of the site:
Co. Name: ____________________________________________________
DEP Contractor ID#: ________
Rep. Name & Title: __________________________________________________________________________
Rep. Phone # & E-mail: _______________________________________________________________________
Allow the DEP to select a competitively procured contractor for the next scope of work in accordance with s. 287.057,
Florida Statute.
I understand that the contractor selection option chosen above cannot be changed once it has been approved by the
Department, unless poor performance by the Contractor is affirmatively demonstrated.
__________________________________________________
___________________________
____________
Responsible Party Rep. Name & Title
Signature
Date
DWM.PRP.Contractor.Recommendations@dep.state.fl.us
or
Completed forms should be emailed to
sent to the
letterhead address, Mail Station 4580, Attention: Robert Perlowski. Questions about cost share site contractor selection
may be referred to Rob Perlowski at 850-245-8917 or at Robert.Perlowski@dep.state.fl.us.
A list of Agency Term Contractors by region is available on the Petroleum Restoration Program Website at
https://floridadep.gov/waste/petroleum-restoration/content/qualified-contractor-information
Cost Share Contractor Recommendation Sheet 71217
PETROLEUM RESTORATION PROGRAM
COST SHARE SITE CONTRACTOR RECOMMENDATION SHEET
The Responsible Party (RP) may use this sheet to recommend an Agency Term Contractor with a contract in the same region
as the site to perform work pursuant to a cost-share agreement in the Petroleum Restoration Program (PRP) that meets the
25% or higher cost share requirement pursuant to Chapter 62-772, Florida Administrative Code, Procurement Procedures
for the Petroleum Restoration Program. The entity selecting the Contractor must be a party to the executed cost share
agreement.
Site Name: ___________________________________________________ FDEP Facility ID#: ___________________
Site Address: __________________________________________________ Parcel ID#: __________________________
Responsible Party Name: _____________________________________________________________________________
Responsible Party Rep. Name & Title: __________________________________________________________________
Responsible Party Rep. Phone # & E-mail: _______________________________________________________________
Select only one of the contractor options listed below:
Recommend a PRP Agency Term Contractor with a valid contract in the region of the site:
Co. Name: ____________________________________________________
DEP Contractor ID#: ________
Rep. Name & Title: __________________________________________________________________________
Rep. Phone # & E-mail: _______________________________________________________________________
Allow the DEP to select a competitively procured contractor for the next scope of work in accordance with s. 287.057,
Florida Statute.
I understand that the contractor selection option chosen above cannot be changed once it has been approved by the
Department, unless poor performance by the Contractor is affirmatively demonstrated.
__________________________________________________
___________________________
____________
Responsible Party Rep. Name & Title
Signature
Date
DWM.PRP.Contractor.Recommendations@dep.state.fl.us
or
Completed forms should be emailed to
sent to the
letterhead address, Mail Station 4580, Attention: Robert Perlowski. Questions about cost share site contractor selection
may be referred to Rob Perlowski at 850-245-8917 or at Robert.Perlowski@dep.state.fl.us.
A list of Agency Term Contractors by region is available on the Petroleum Restoration Program Website at
https://floridadep.gov/waste/petroleum-restoration/content/qualified-contractor-information
Cost Share Contractor Recommendation Sheet 71217