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<t - <br /> ` MovwG a sroRnGE + ~ + OREGON DOT # 44612 <br /> WUTC#HG1324 J0~28489 <br /> 3330 Roosevelt Blvd. -Eugene; OR 97402-6531 - <br /> 1 I LILE INTERNATIONAL COS.. .PHONE: (503) 7264800 EMAIL dispatch~lile.net SALESPERSON #i SALESPERSON #2 <br /> r 8060 SW PFAFFLE ST., SUITE 200, TIGARD, OR 97223 FAX: (603 726-4894 W W W: htt ://wa?w.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 /> ~i. move, pack, store, and/or perform services shown. Before you sign this document it is impodanl that you first read the entire document, including the back 03/09/09 03/09/09 <br /> I and that you ask for an explanation of anything Thal is noI 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 subject to terms and conditions printed on the back of this form. _ _ _ _ <br /> I SHIPPER i CONSIGNEE <br /> NAME City Of EUg2t12 - PUbIIC WOrkS ~ NO. NAME $f11PP6f NO. <br /> f <br /> i ADDRESS 101 E. Bf08dW8)I ADDRESS O11-SItO - <br /> j CITY Eugene STATE OR ZIP 97401 CITY EUgQne STATE OR ZIP <br /> ' CONTACT Karen CONTACT <br /> S <br /> j PHONE 682 5241 ALT. PHONE EMAIL PHONE ALT. PHONE EMAIL <br /> €CI PAYMENT INFORMATION BILLING INFORMATION <br /> f PAYMENT TYPE ? PREPAID ? COD ~ ACCOUNT APPR. NAME City Of EU90f10-PUbIIC WOfkS NO. <br /> Ill ADDRESS <br /> j. PAYMENT METHOD ? CASH ? CREDIT/DEBIT CARD ? PERSONAL CHECK - CITY STATE ZIP <br /> ff€ ? WIRE ? CASHIER'S CHECK <br /> ATTN. PO/GBL NO. _ <br /> PROPERTY DESCRIPTION - ADDITIONAL PICKUPIDELIVERI' <br /> ~ ~ ~ NAME <br /> ADDRESS <br /> ` CITY STATE ZIP <br /> g CONTACT <br /> g7 PHONE ALT. PHONE ~ EMAIL <br /> p. RELEASE OF <br /> E GOODS: DATE: <br /> <br /> ~j RECEIPT OF <br /> V GOODS _ _ DATE: <br /> HOURLYRATEDMOVES <br /> t t <br /> i~ ~ ~ r <br /> REQUIRED EQUIPMENT <br /> - - - MILEAGE RATED MOVES QTY. RATE CHARGES <br /> ACTUAL SHIPMENT WEIGHT (Ibs.) gross tare net <br /> ~ REWEIGH/EXPEDITED SHIPMENT WEIGHT ross tare riet <br /> MILEAGE miles <br /> 33Sp[[[ SPECIAL Ity$TRU_C_TIONS_ BILLED SHIPMENT WEIGHT lbs. /cwt. <br /> <br /> f ; FUEL SURCHARGE `3.00 <br /> ADDITIONAL SERVICES QTY RATE CHARGES <br /> q. f <br /> g .mss.,.. " <br /> VALUATION STATEMENT + <br /> k UNLESS A HIGHER VALUE IS DECLARED, THE SHIPPER HEREBY RELEASES THE PROPERTY TO A VALUE NOT SUBTOTAL <br /> i TO EXCEED $.60 PER POUND PER ARTICLE. WHEN EXCESS VALUE IS DECLARED,A PREMIUM OF $.86 PER ~ <br /> I -.5100:00 OF DECLARED VALUE WILL APPLY. OTHER _ ~'i <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 ENT COLLECTED ~ <br /> UNDER NO CIRCUMSTANCES W ILL A CLAIM BE PROCESSED FOR MORE THAN THE CARRIER'S RELEASED PAST BALANCE DUE _ <br /> LIABILITY UNCLESS AN EXCESSVALUE HAS BEEN DECLARED AND THE APPROPRIATE PREMIUM COLLECTED ~ <br /> r FOR THAT VALUE. ~ ~ ' ~ _ ~ _ _ <br /> 3 COMMENTS/EXCEPTIONS <br /> t DECLARED <br /> ..VALUE: <br /> s. <br /> SHIPPER: ~ DATE: <br /> s _ <br /> ? EXPEDITED SHIPMENT: MOVING AT EXPEDITED WEIGHT OF lbs. <br /> SHIPPER: DATE: <br /> - ? OVERTIME AUTHORIZED:cwl./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 /> RELEASEOF - 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: _ GOODS/CONSIGNEE: DATE: <br /> <br />