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Date Ser. Req'd: ~ ani/pm <br />Pack Date: am/pm <br />Delivery Date Req'd: .L ~. ' am/pm <br />Order Taken By: <br />_.~ ~:.~~~,..:A.~ . ~ ,. r <br />ti+ra~r~~~f. ~i~ ~~ :` <br />1465 .fOhr~son 5t, i~tE, Sa'em, flR 3iT <br />~) 5$i-66i~i ~ (~t?t}) 828-i6rt2 • €sx (5t33~1-6824 <br />" Pt#~ ~373~2 * iCC ~ 22+T~5 <br />e.~ y ~~~f ~ - ~ ~- -~~ <br />HHG B~;LL OF LADING <br />` B/L Number <br />`3512 <br />. <br />. <br /> • <br />NAME NAME <br />Marion County Victim Assitance Dept. Same <br />ADDRESS ADDRESS <br />220 High St NE ±;.~ <br />CITY SfATE ZIP CITY ;, STATE ZIP <br />Salem OR ` Salem ~` -' <br />OR <br /> . <br />~ , <br />CONTACT PHONE CONTACT PHONE <br />Pam Middlesetter F,,,,~ 588-5253 "~.~" .. <br />FAX <br />t START TIME: . Q['~ <br />~ <br />I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I <br />I I I I I I I I I INITIAL /pm <br />6 AM 7 8 9 10 11 12 1 2 3 4 5 6 PM FINISH TIME: ~~ <br />NOON <br />EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING X-TIME NOT CHARGED INITIA /pm <br />• <br />~ ~~~~; ~4~1'~' " ~ ~' ; e ~ ~ ~ ,~e~ <br />` ~' ~" ~ ~ ,(~r'-EJI.r~/"~-~. 1 TRUCK 8 DRIVER . '~~ ~ U J <br /> <br />BARRELS/DISHPACKS _ _. _ <br />TRUCK & MEN _ _ . _ __ . <br />CRATES/CONTAINERS r.'' r - ~+ "' /!? 0. ~' J EXTRA LABOR HOURS .~ ..3 <br />CARTONS: 1b CU FT. IOO.OO MATERIALS ' /~~ ~J~ <br />3.0 CU FT OTHER <br />4.5 CU FT 7 /S.~,Yf'_.` <br />6.0 CU FT <br />WARDROBE CARTON ~~~~ <br />MIRROR CARTON • ' • <br />MATTRESS CTNS: SiNG~e <br />DOUBLE <br />OTHER <br />aTHER: aFe 25.00 <br /> ~~ /(.) .C J <br /> ~ ~~: tw . ~ v <br /> . . . . . <br /> <br />If the shipper declines to sign this declaration of value and the shipment is accepted, DATE OF PICKUP REUUESTED ~ DATE OF DELIVERY REQUESTED <br />the shipment will move at the depreciated value protection level and the shipper will <br />be subject to the appropriate valuation charges. 3-~+-+4TU TAGAEEt~NT 70 ~S ' DATE SIGNED <br /> <br />. , <br />_ <br />~ <br />~ <br /> <br />^ RELEASED V E PROTECTION: , <br />, <br />~~ <br />, . ~ , . <br />Goods w' ue at 60 ents'~er~T6: "per article. . <br />'~f' t3F~SS WT. 't14f'~ Wt ~ ~' N~"T' n <br />~: ~~ ; <br />Shi D e: <br />~ <br />~ MILES: ~y _ ; ^ <br />^ DEPRECIATED VALU ROTECTION: Goods will be v~af ed at $1 <br />25 times the . <br />. <br /> <br />_ ,, <br />:.~n <br />_ acttratvveigMvttheshipment:foreach S~F(~:06,-orfractivn theroof, of declared value _ . _ _. _ _ _ , _ _. . _ _- - ,-- - . .- <br />~ <br />at $1 <br />25 times the weight of the shipment in Ibs. or cl,eciared1Wr1p~r~R~lue, whichever CHARGES FROM ABOVE ~ <br />; <br />is hi <br />her <br />the val <br />ation char <br />e shall be 50 cen <br />r eadf(:$40460 of val <br />e ' <br />~ <br />g, <br />, <br />g <br />u <br />pe <br />u <br />. <br />~ OTHER CHARGES <br />~ <br />~. <br />Shipper: <br />Date: <br />~,~` <br />'~~ ` ` <br />Lump Sum Value: STORAGE CHARGES ' <br />` <br />/ ' ' <br />w <br />~ <br />~ VALUATION CHARGES <br />^ REPLACEMENT COST PROTECTION: Gobds <br />iil ~e ralueff <br />$3.50 times the <br />a <br />actual weight of the shipment. For each $100.00, or frae~ioa tKereof, of declared value <br />^~' <br />~j ~~jA~~~,• ' J <br />/ 3~ <br />~ ~ <br />~ <br />at $3.50 times the weight of the shipment in Ibs. or declared lump skn'r,~lue, whichever <br />' <br />' ~ <br />~ - <br />~ <br />is higher, the valuation charge shall be 85 cents per epch,~ <br />1b <br />~b of value. <br /> <br />~ qDVANCE DEPOSIT <br />Shipper: <br />Date: <br />Lump Sum Value: _ - ~~~~ ~~~ <br />, • <br /> {' <br />I acknowledge that 1 haVe received, ~t the first contacCwith the carrier, a copy of the C.O:D. <br />BILL PAID <br />form eMRled GENERAL INFORMATION`FOR MOVING HOUSEHOLD GOODS OR RE~EIVED 1 CO ITION PT AS NOTED: <br />~ <br />OFFICES IN OREGON which explains the Oregon rules and regulations affecting ~~"' <br />2~ <br />intrastate shipments of household goods and office furniture and fixtures. C . <br />I understand that my final charge for service mu~t l~e based on rates that have been <br />~ <br />^ <br />~ <br />^ ~' <br />a roved b the Public Utilit Commission and ublished (n a tariff re ardless of an <br />PP Y Y P 9 Y ~- "'~ ' <br />' <br />-~` <br />" <br />Driver. <br />estimate for service provided to me by the carrier. I UNDERSTAND 7HAT AN ESTIMATE COMMENTS/ EXCEPTIONS: <br />IS NOT A FIRM BID. <br />D <br />t <br />d <br />a <br />e <br />: <br /> <br />Shipper: ~. <br /> <br />Carrier. <br /> <br />WTB NO. 50 <br />T39f~it Ii4 Se'CC <br />