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I ~ ~ <br /> P MovING a sroRAGE ~ ~ ? OREGON DOT # 44612 ~ ~r <br /> ~ ~ ~ _ WUTC#HG1324 JOO28489 <br /> 3330 Roosevelt Blvd. -Eugene, OR 97402-6531 <br /> t I LILE INTERNATIONAL COS PHONE: (503) 726-4800 EMAIL: dispatch®lile.net SALESPERSON #1 SALESPERSON #2 <br /> r 8060 SW PFAFFLE ST., SUITE 200, TIGARD, OR 97223 FAX: 503 726-4894 W W W: hit ://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 pertorm services shown. Before you sign this document it is important ihafyou firs) read the entire document, including the back 03/09/09 03/09/09 <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 DATERIME <br /> tative(sl. This contract is subject to terms and conditions printed on the back of this form. <br /> SH(PPER CONSIGNEE <br /> NAME City of Eugene -Public Works NO. NAME Shipper NO. <br /> ADDRESS '101 E. Br08CfWey ADDRESS On-Site <br /> CITY Eugene - /STATE OR ZIP 97401 -CITY Eugene STATE_ OR ZIP <br /> CONTACT Karmen - CONTACT <br /> PHONE 682-5241 ALT FI fONE EMAIL PHONE ALT. PHONE EMAIL <br /> _ _ - <br /> ~ PAYf~4ENT INFORP,iATION BILLING INFORMATION <br /> PAYMENT TYPE ? PREPAID ? COD ~ ACCOUNT APPR. NAME Clty Of Eugene-PUbIIC WOrkS NO. „4 ~i <br /> - ~ ADDRESS r r r' rrt r-< ¢ . ~°V: ~ i x "'d d•``x <br /> sta. <br /> PAYMENT METHOD ? CASH ? CREDIT/DEBIT CARD ? PERSONAL CHECK n ~ ~ ~ <br /> CITY STATE ZIP ~,a <br /> ? WIRE ? CASHIER'S CHECK ~ <br /> ATTN. ~ l PO/GBL NO. <br /> II PROPERT`f DESCRIPTION ADDITIOIJ~ACPICKUP/DELIVEpY <br /> NAME <br /> ADDRESS <br /> ,I. CITY STATE ZIP <br /> CONTACT <br /> PHONE ALT. PHONE .EMAIL <br /> RELEASE OF <br /> i GOODS: DATE: <br /> ll RECEIPT OF <br /> GOODS: - DATE: <br /> j HOURLY RATED MGVES <br /> 1 ~ <br /> I <br /> ~ REQUIRED EQUIPMENT <br /> - - - <br /> <br /> -J ~ - MILEAGE RATED MOVES QTY:. RNTE CHARGES <br /> ! ACTUAL SHIPMENT WEIGHT (Ibs.) gross tare net <br /> j <br /> REW EIGH/EXPEDITED SHIPMENT WEIGHT gross tare net <br /> MILEAGE miles <br /> SPECIAL INSTRUCTIONS BILLED SHIPMENT WEIGHT lbs. /cwt. <br /> ~ <br /> j FUEL SURCHARGE 3.00 <br /> I ADDITIGNALSEFIVICES QTY. RATE CHARGES <br /> - - <br /> ~I <br /> ' VALUATION STATEMENT. ~ <br /> UNLESS A HIGHER VALUE IS DECLARED, THE SHIPPER HEREBY RELEASES THE PROPERTY TO A VALUE NOT SUBTOTAL - Ij <br /> TO EXCEED $.60 PER POUND PER ARTICLE. WHEN EXCESS VALUE IS DECLARED, A PREMIUM OF $.85 PER ~ <br /> $100.000 DECLARED VALUE WILL APPLY. OTHER <br /> IN THE EVENT A CLAIM IS FILED FOR LOSS OR DAMAGE, FINAL SETTLEMENT WILL BE BASED UPON THE <br /> CARRIER'S LIABILITY OF$.60 PER POUND PER ARTICLE OR THE DECLARED VALUE AS SPECIFIED BELOW. PREPAYM ENTCOLLECTED <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 /> FORTHATVALUE. ~ ~ _ ' <br /> DECLARED COMMENTS/EXCEPTIONS <br /> VALUE: <br /> SHIPPER: - - ~ - DATE: <br /> s . _ s <br /> ? EXPEDITED SHIPMENT: MOVING AT EXPEDITED WEIGHT OF lbs. <br /> 1 SHIPPER: DATE: <br /> ? OVERTIME AUTHORIZEDi - 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 /> RELEASE OF ORIGINAL <br /> GOODS/CUSTOMER.(ORIGIN): DATE: <br /> NOT NEGOTIABLE <br /> RECEIPT OF GOODS/ <br /> DRIVER (ORIGIN): DATE: <br /> DELIVERING .RECEIPT OF <br /> DRIVER: ~ ,t _ DATE: GOODS/CONSIGNEE: DATE: <br /> <br />