Laserfiche WebLink
Date Ser. Req'd: 3-19-97 am/pm. <br />R~:IAL .. ;3-•~1+!~-97 amlpm <br />Delivery Date Req'd: !}- /„Z ~- am/pm <br />Order Taken By: TOM <br />Capi~al Ci~ `Transfer = ~ <br />~ 14v5 Johnson St. NE,`•~Salem, OR 973~ <br />(503) ~81-6883 • (800) 828-164i • fax (5D3) 581-fi92 ; <br />,~ PUC ~037342 o iCC MC 227345 <br />„s r:Tf~ r i_' ~ -~,i. ~; - ,• j <br />HHG B~LE aF L~4DING <br />B]'L Number <br />35`74 <br />NAME NAME r, <br /> i~ <br />FISCAL SERVICE-MARION COUNTY FISCAL SERVICE-MARION COUNTY <br />ADDRESS ADDRESS <br />220 HIGA STREET 4th FLOOR <br />CITY STATE ZIP CITY STATE ZIP <br />SALEM OR <br />CONTACT PHONE CONTACT PHONE <br /> <br />ELYN LYON FAX ~ <br />Fqx <br /> S TART TIME: <br />I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I IN ITIALS am/ <br />m <br />6 AM 7 B 9 10 11 12 1 2 p <br /> <br />NOON 3 4 5 6 Pti1 FI NISH TIME: <br />EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING X-TIME NOT CHARGED IN ITIALS am/pm <br /> • <br />NIA7Ei31AL$ : MA TEEUAL F/-CKINCi ~wCICINt'R AMOUNT NIOYIHG UNITS RT 1C~f i~C[ <br /> QTY. RATE Q?Y. RATE QTY. RATE - 1 TRUCK & DRIVER S4. 6S J j" <br />BARREL`SlDtSHPAEKB ' : < . . . ° TFtUCK "& 2 MEN • - . - ---- -----. _ _ _. . _ _. - <br />CRATES/CONTAINERS ~y ~ ~ ~j ~j' ? ` _ ~'~(.:_ J EXTRA LABOR HOURS <br />CARTONS: 1.5 CU FT. SO 1. OO ~• U~ MATERIALS ~~"" <br />3.OCUFT (!,) ~.4;~ I -- `~•C~.1 OTHER <br />4.5 CU FT ~:,~ ~'~ ~ - <br />6.OCUFT 1 ~~ <br />WARDROBE CARTON ,~ ~(~, -r'j / <br />MIRROR CARTON • • - ~ ~ - <br />MATTRESS CTNS: SiNG~E <br />' j 1 v 7j~~ <br />a <br />DOUBLE ~ SQ ~ ~ ~ J ~ <br />, <br />`~ / .N, <br />rt~ <br />OTHE ~ rS J ~~'~ 7 ~(~ `3 b: <br />OTHER: TAPE S 2. 50 " d <br />I RS C <br />SU~'I'OTAL M • =+~ + :J'`-D Stt~'C~TAL 1- <br />. . • . . <br />If the ~shipper declines to sign this declaration of value and the shipment is accepted , DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTEO <br />the shipment will move at the depreciated value protection level and the shipper wi ll <br />be subject to the appropriate valuation charges. SIGNatuRe7AGFlEeMEhtT'TO HiGHEA GHnRGes ' ~nre siGrve~ <br />^ RELEASED VALUE PROTECTION: ~ ; . ~ ~ . . <br />Goods will be ued at ce Ib. er article. <br />,,~, , <br />f <br />~ <br />Shi <br />er: ' l D <br />~t' ~%f~ <br />t GHOSS WT. 'TAFtE NR. NE'~ "1~Yt: <br />pp <br />a <br />e: <br />~ MILES: ~ <br />^ DEPRECIATED VALUE PROTECTION: Goods will be valued at $1.25 times the <br />t <br />l <br />i <br />ht <br />f th <br />hi <br />F <br />h <br />ac <br />ua <br />we <br />g <br />o <br />e s <br />pment. <br />or eac <br />$100.00, or fraction thereof, of declared value <br /> <br />at $1.25 times the weight ofi the shipment in Ibs. or declared luinp sum value, whichever EWARGES°FAORA'1~cBOVE-' . _. _.. ,:_ _ . :_..- . <br />~ <br />is higher, the valuation charge shall be 50 cents per each $100.00 of value. <br />~~~ GES <br />Shipper: Date: ,~~ W`,'' <br />Lump Sum Value: STORAGE CHARGES <br /> <br />^ REPLACEMENT COST PROTECTION <br />G VALUATION CHARGES , <br />: <br />oods will be valued at $3.50 times the - <br />actual weight of the shipment. For each $100.00, or fraction thereof, of declared value ~~ ~~R~~- /yo ~~ <br /> <br />at $350 times the weight of the shipment in Ibs. or declared lump sum value, whichever <br />is hi <br />h <br />r <br />th <br />l <br />ti <br />h <br />h <br />ll b <br />85 <br />h <br />~~ ~~ <br />/ . <br />g <br />, <br />e va <br />e <br />ua <br />on c <br />arge s <br />a <br />e <br />cents per eac <br />$100.00 of value: <br /> ADVANCE DEPOSIT <br />Shipper: Date: -°~ <br />~ <br />' <br /> ti <br />~ f ~ <br />Lump Sum Value: <br />- ~`~N~~ ~~~~ <br />; ~~9~r ~~ <br />. . . <br />1 acknowledge that I have received, at the first contact with the carrier, a copy of the C.O.D. ILL PR EPAID <br />form entitled GENERAL INFORMATION FOR MOVING HOUSEHOLD GOODS OR RECEIVED IN D CONDITIO S NOTED: <br />OFFICES IN OREGON which explains the Oregon rules and regulations affecting <br />intrastate shipments of household goods and office furniture and fixtures. Consignee: - <br />I understand that my finai charge for service must be based on rates that have been _ ~_- - <br />~ <br />~ ~ / <br />approved by the Public Utility Commission and published in a tariff regardless of any Driver. L " <br />' <br />estimate for service provided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE COMMENTS/ EXCEPTIONS: <br />IS NOT A FIRM BID. ~- <br />Dated: <br /> <br />Shipper. <br /> <br />Carrier. <br /> <br />. <br />WTB NO. 50 <br />