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I , <br /> ~~~~'MOVZNG a sroRAGE 3' ' OREGON .DOT # 44612 - <br /> , ~ T `Q~'] <br /> WUTC#HG 1324 IU oO~~V VJ <br /> 3330 Roosevelt Blvd:'- Eugene, OR 97402-6531 ~ - <br /> ~ I LILE IIyTERNATIONAL COS PHONE: (503) 726-4600 EMAIL: dispatch®lile.net .SALESPERSON #1 SALESPERSON N2 <br /> t 8060 SW PFAFFLEBT., SUITE 200, TIGARD, OR 97223 FAX: 503) 726-4694 W W W: http://www.lile.net KEITH NICHOLS ENGEL / 33 / <br /> CUSTOMER: This bill of lading establishes a conirad between you and the trans. provides It confirms instructions and authorizes the carrier to AGREED PICKUP DATElTIME <br /> AGREED DELIVERY DATE/TIME <br /> move, pack, store, and/or pertorm services shown. Before you sign this document it isimportant that you first 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 rereived from the carrier or carrier's7eprese ACTUALPICKUP <br />DATE/TIME ACTUAL DELIVERY DATE/TIME <br /> tative(s) This contract is subject to ierms~arid conditions printed on the back of this form. _ _ <br /> SHIPPER CONSIGNEE <br /> NAME City of Eugene -Public Works NO. NAME Shipper No. <br /> ADDRESS 858 Pearl Street First Floor ADDRESS 858 Pearl Street First Floor <br /> CITY Eugene .STATE OR ZIP g74O1 CITY Eugene STATE ~R ZIP <br /> corlrncT Morgan McFadden coNTACT <br /> i PHONE 6$Z-$421 ALT. PHONE EMAIL PHONE ALT. PHONE EMAIL <br /> PAYMENT INFORMATION BILLING INFORMATION <br /> PAYMENT TYPE ~ ? PREPAID ? COD - ~ ACCOUNT APPR. p: ~ NAME - Clty Of Eugene-PUbIIC WOrkS NO. <br /> - -ADDRESS - - <br /> PAYMENT METHOD ? CASH ? CREDIT/DEBIT CARD ? PERSONAL CHECK CITY STATE ~ ZIP <br /> ? WIRE ? CASHIER'S CHECK _ <br /> ATTN. p0/GBL NO. <br /> PROPERTY DESCRIPTION ADDITIONAL PICKUP;DELIVERY I <br /> NAME - <br /> ADDRESS <br /> _ CITY STATE ZIP - <br /> CONTACT <br /> PHONE ALL PHONE EMAIL <br /> RELEASE OF - <br /> GOODS: DATE: <br /> RECEIPT OF <br /> GOODS: - DA7E~ - <br /> HOURLY RATED MOVES <br /> i ~ r <br /> _ r I ~ <br /> - <br /> ' REC]UIRED EC)UIPt\-1ENT s ~ a t - ~ <br /> ...w @ <br /> MILEAGE RATED MOVES QTY RATE CHARGES <br /> ACTUAL SHIPMENT WEIGHT (Ibs.) gloss tare net <br /> REWEIGH/EXPEDITED SHIPMENT WEIGHT gross tare net <br /> MILEAGE miles <br /> I <br /> SPECIAL INSTR_U_CTIONS BILLED SHIPMENTWElGHT lbs. /cwt. <br /> FUEL SURCHARGE x•00 <br /> ADDITIONAL SERVICES QTY. RATE CHARGES <br /> - <br /> c. i , i <br /> VALUATION STATEMENT ~ <br /> UNLESS A HIGHER VALUE IS DECLARED, THE SHIPPER HEREBY RELEASES THE PROPERTY TG A-~dALUE NOT $UBTOTAI. <br /> TO EXCEED $.60 PER POUND PER ARTICLE. WHEN EXCESS VALUE IS:DECLARED, A PREMIUM OF $.85 PER ~ <br /> $100.00 OF DECLARED VALUE WILL APPLY. - OTH ER <br /> IN THE EVENT A CLAIM IS FILED FOR LOSS OR DAMAGE, FINAL SETTLEMENT WILL BE BASED UPON THE - S. <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 THEAPPROPRIATE PREMIUM COLLECTED ~ <br /> FOP THAT VALUE. ~ ' ~ ~ I <br /> i ~ ~ COMMENTS/EXCEPTIONS <br /> DECLARED ° <br /> VALUE: ~ ~ w ,>M IT t <br /> SHIPPER: ~ - ~ ~ DATE: <br /> ? EXPEDITED SHIPMENT: ~ MOVING AT EXPEDITED WEIGHT OF lbs. <br /> SHIPPER:` DATE: <br /> ? OVERTIME AUTHOR2ED: ~ .cwt./hours, - - <br /> SHIPPER: DATE: <br /> i ALL GOODS WERE RECEIVED IN GOOD CONDITION, EXCEPT AS NOTED <br /> ON THIS CONTRACT OR ON THE INVENTORY FORM. <br /> RELEASE OF ~ - - <br /> <br /> h GOODS/CUSTOMER (ORIGIN): _T{ -DATE: .ACCOUNTING <br /> RECEIPT OF GOODS/ , - ~ - <br /> DRIVER (ORIGIN): DATE: (FO.RWARD TO CORP. OFFICE) <br /> r <br /> DELIVERING RECEIPT OF <br /> 1 .DRIVER: - DATE. GOODS/CONSIGNEE: DATE: <br /> ~ ~ ~ <br /> <br />