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r MovING & sTORAGE + _ OREGON DOT # 44612 <br /> ,i~i,i ~ ~ WUTC # HG 1324 <br /> J0028683 <br /> 3330 Roosevelt Blvd.- Eugene, OR 97402-6531 <br /> 1 I LILE INTERNATIONAL COS PHONE: (503) 726-4800 EMAIL: dispatch®lile.net SALESPERSON #i SALESPERSON #2 <br /> t 8060SW 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. It confirms instructions and authorizes the carrier to AGREED PICKUP DATE/TIME <br /> - AGREED DELIVERY DATE/TIME <br /> move, pack, store, and/or perform services shown. Before you sign this document it is important that you firs) read the entire document, 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 /> tative(s) This contract is sublect to terms and conditions printed on the back of ibis form. <br /> - _ <br /> ISHIFPER rCONSIGNEE <br /> NAME ~'ilty Of Eugene - PUbIIC WOfI(S NO. NAME $hIPPeF NO. <br /> ADDRESS 858 Pearl Street First Floor ADDRESS -858 Pearl Street First Floor <br /> CITY Eugene STATE OR ZIP 87401 ~ CITY -Eugene STATE ~R- ZIP <br /> CONTACT MOrgan McFadden - CONTACT <br /> PHONE BHZ-H4Z1 ALT. PHONE EMAIL PHONE ALT. PHONE EMAIL <br /> PAYMENT INFORMATION ~ BILLING INFORMATION <br /> ' - - ----'I <br /> PAYMENT TYPE ? PREPAID ? COD ~ ACCOUNT APPR. NAIAE CItY OT EUgene-PUbIIC WOf{(S NO. <br /> ADDRESS <br /> PAYMENT METHOD ? CASH ? CREDIT/DEBIT CARD ? PERSONAL CHECK CI I Y STATE ZIP <br /> ? WIRE ? CASHIER'S CHECK <br /> ATTN_ PO/GBL NO. <br /> PROPERTY DESCRIPTION - ADDITIONAL PICKUP/DELIVERY <br /> NAMF <br /> - ADDRESS <br /> CITY STATE ZIP <br /> CONTACT <br /> PHONE' ~ ALT. PHONE EMAIL <br /> RELEASE OF - <br /> GOODS DATE: <br /> RECEIPT OF , <br /> GOODS DATE: <br /> HOURLI' RATED (d~OVES <br /> i ~ ~ r <br /> - - <br /> REQUIRED EQUIPMENT - w. ~ <br /> f <br /> MILEAGE RATED MOVES QTY. RATE CHARGES . <br /> ACTUAL SHIPMENT WEIGHT (Ibs.) gross tare net <br /> REWEIGH/EXPEDITED SHIPMENT WEIGHT<, gross tare net <br /> _ MILEAGE - ~ miles <br /> .SPECIAL INSTRUCTIONS BILLED SHIPMENT WEIGHT lbs. /cwt. <br /> <br /> i <br /> FUEL SURCHARGE <br /> ADDITIGNALSERVICES OTY. RATE CHARGES <br /> - <br /> , i i• <br /> EVALUATION STATEMENT ' ~ <br /> UNLESS A HIGHER VALUE IS DECLARED, THE SHIPPER HEREBY RELEASES THE PROPERTY TO A VALUE NOT SUBTOTAL ~ I I <br /> TO EXCEED $.60 PER POUND PER ARTICLE. WHEN EXCESS VALUE IS DECLARED, A PREMIUM OF $.86 PER - - <br /> $100.00 OF DECLARED VALUE WILL APPLY. ..OTHER $ <br /> IN THE EVENT A CLAIM IS FILED FOR LOSS OR DAMAGE, FINAL SETTLEMENT W ILL BE BASED UPON THE - <br /> CARRIER'S LIABILITY OF$.60 PER POUND PER ARTICLE OR THE DECLARED VALUE AS SPECIFIED BELOW. PREPAYMENT COLLECTED <br /> UNDER NO CIRCUMSTANCES WILL A CLAIM BE PROCESSED FOR MORE THAN THE CARRIER'S RELEASED PAST BALANCE DUE ' <br /> LIABILITY UNCLESS AN EXCESS VALUE HAS BEEN DECLARED AND THE APPROPRIATE PREMIUM COLLECTED <br /> FOR THAT VALUE. ~ <br /> COMMENTS/EXCEPTIONS <br /> DECLARED <br /> VALUE: <br /> } <br /> SHIPPER: ' DATE: <br /> s <br /> ? EXPEDITED SHIPMENT: ! MOVINGAT 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 /> f ~ ON THIS CONTRACT OR ON THE INVENTORY FORM. <br /> RELEASE OF ~ ~4 ~ ORIGINAL <br /> GOODS/CUSTOMER (ORIGIN): _ DATE: <br /> / NOT NEGOTIABLE <br /> RECEIPT OFGOODS/ - <br /> DRIVER (ORIGIN): DATE: <br /> DELIVERING RECEIPT OF <br /> DRIVER: DATE: GOODS/CONSIGNEE: DATE: - <br /> <br />