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<a_..,.~ <br /> MovwG a sTORAGE • ~ ; OREGON DOT # 44612 <br /> WUTC#HG1324 J~~2a6a3 <br /> t - 3330 Roosevelt Blvd. -Eugene, OR 97402-6531 <br /> r I . ULE INTERNATIONAL COS PHONE: (503) 726-4800. EMAIL: dispatch®lile.net SALESPERSON #7 ~ SALESPERSON #2 - <br /> r 8060 SN/'PFAFFLE ST., SUITE 200, TIGARD, OR 97223 FAX: (503) 726-4894 W W W: htt ://www.lile.net KEITH NICHOLS ENGEL / 33 / <br /> CUSTOMER: This bill of lading establishes a contract between you and the Trans: provider. II confirms instructions and authorizes the carrier to AGREED PICKUP DATE/TIME <br /> AGREED DELIVERY DATE/TIME <br /> move, pack, store,. and/or pedorm services shown. Before you sign this document itis imponaN that you first read the entiredocumenl, including the back 03/24/09 8:30 AM- 8:30 <br />AM 03/24/09 8:30 AM- 8:30 AM <br /> and that you ask for an explanation of anything that is not clear or that is different from any previous information received from the carrier or carrier's represe ACTUAL PICKUP <br />DATE/TIME ACTUAL DELIVERY DATE/TIME <br /> I tative(s) This contract is subject to{erms and conditions printed on the back of this form. <br /> ;SHIPPER li CONSIGNEE --I <br /> ! - - - <br /> NAME Clty Ot EUgene.- PUI)IIC WOrk$ ~ NO. NAME $I11PFlef - NO. <br /> ADDRESS 858 Pearl Street First Floor ADDRESS 858 Pearl Street First Floor <br /> CITY Eugene STATE OR ZIP 97401 CITY EUgene STATE ~R ZIP <br /> coNTncT Morgan McFadden coNTACT <br /> PHONE 682-8421 ALT. PHONE EMAIL PHONE ALT. PHONE EMAIL <br /> PAYMENTINFORMATION i BILLING WFORMATION ~ <br /> PAYMENT TYPE ~ PREPAID ~ COD ~ ACCOUNT APPR. H: NArdE Clty Ot EUgene-PUbIIC WOrI(S NO. <br /> ADDRESS <br /> ~ PAYMENT METHOD ? CASH CREDIT/DEBIT CARD ~ PERSONAL CHECK ~ CITY STATE ZIP <br /> WIRE ~ CASHIER'S CHECK <br /> _ ATTN. _ PO/GBL NO.. _ _ _ <br /> I PROPERTY DESCRIPTION -ADDITIONAL PICKUP/DELIVERY ~~I <br /> NAME. <br /> tftf ~ ADDRESS <br /> f ~ CITY STATE ZIP <br /> If CONTACT <br /> j ~ ~ PHONE ~ ALT. PHONE - EMAIL <br /> RELEASE OF - <br /> ~ ~ GOODS: DATE: <br /> RECEIPT OF <br /> ~„".r GOODS -0ATE~ <br /> HOURLY RATED MOVES <br /> i ~ r ~ . <br /> , , <br /> ;REGIUIREDEOUIPMENT. <br /> i <br /> t <br /> k <br /> t . <br /> f. <br /> I MILEAGERATED MOVES` _ QT`f. RATE CHARGES ~i <br /> ACTUAL SHIPMENT WEIGHT (Tbs.) gross tare net <br /> REWEIGH/EXPEDITED SHIPMENT WEIGHTa,. gross tare net <br /> ~ MILEAGE miles <br /> ISPECIALINSTRUCTIONS <br /> T-w-__ ' BILLED SHIPMENT WEIGHT - lbs. /cwt. ` <br /> FUEL SURCHARGE O.OO <br /> ADOITIONALSERVICES QTY. RATE CHARGES <br /> VALUATION STATEMENT ~ <br /> UNLESS A HIGHER VALUE IS DECLARED, THE SHIPPER HEREBY RELEASES THE PROPERTY TO A VALUE NOT $U BTOTAL SJ <br /> TO EXCEED $.60 PER POUND PER ARTICLE. WHEN EXCESS VALUE IS DECLARED, A PREMIUM OF $.85 PER - <br /> i $100.000F DECLARED VALUE WILL APPLY. OTHER <br /> I IN THE EVENT A CLAIM IS FILED FOR LOSS OR DAMAGE,.FINAL SETTLEMENT WILL BE BASED UPON THE ~ <br /> CARRIER'S LIABILITY OF $.60 PER POUND PER ARTICLE OR THE DECLARED VALUE ASSPECIFIED BELOW. PREPAYMENT COLLECTED _ _ ~d i <br /> - UNDER NO CIRCUMSTANCES WILL A CLAIM BE PROCESSED FOR MORE THAN THE CARRIER'S RELEASED PAST BALANCE DUE ~P` ~I <br /> ' ~ LIABILITY UNCLES AN EXCESS VALUE HAS BEEN DECLARED ANDTHE APPROPRIATE PREMIUM COLLECTED -1-- <br /> FOR THAT VALUE. ~ r ~ ~ _ _ ~ ~ _ _ <br /> COMMENTS/EXCEPTIONS <br /> DECLARED - <br /> -VALUE <br /> SHIPPER: DATE: <br /> • <br /> I ~ EXPEDITED SHIPMENT: MOVING AT EXPEDITED WEIGHT OF _ lbs. <br /> SHIPPER: ~ DATE: - . <br /> .OVERTIME AUTHORIZED: .cwt./hours <br /> SHIPPER: DATE: <br /> ALL GOODS WERE RECEIVED IN GOOD CONDITION,~EXCEPT AS NOTED <br /> ~ ON THIS CONTRACT OR ON THE INVENTORY FORM. - <br /> <br /> . RELEASE OF ~ - ORIGINAL <br /> GOODS/CUSTOMER (ORIGIN): - ~ DATE: <br /> NOT NEGOTIABLE <br /> RECEIPT OF GOODS/ <br /> DRIVER (ORIGIN): DATE: (GIVE TO CONS. AT DEST.) <br /> DELIVERING - RECEIPT OF <br /> DRIVER: ~ DATE: DATE: <br /> GOODS/CONSIGNEE: <br /> <br />