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Date Ser. Req'd: 3~-~°n ~ am/pm <br />Pack Date: 't~---• ~ am/pm <br />Delivery Date Req~a: 4~°'-'97 am/pm <br />Order Taken By: ~ixral`7:1 <br />r ~ ~~ ~~~~~ ~ G'~t~ Trar~~~er <br />°14~5 Johnson 5t. IVE, Saler:~. OR 97~0~~ <br />~ <br />,~U3! 58i-~633 g(8fl0} 823-1641 d it:r, (~Q3) Sbi-69?=~ <br />PUC ~tv37342 e iCC MC ~2i;;45 <br />' ~r %rr~'~'; - - . - . <br />HHG BILL_OF LADING__ <br />B/L Number <br />3~~4 <br /> <br />NAME <br />P~BLIC WORKS NAME • <br />~'UBi,IC WOttk:~ <br />ADDRESS ^~ -~ ` ~ ~ I ~ <br />~...,~~' / c.+ /~ J <br />--5~~°~r-t--~t-~- AiE (3rd F1a~cr1 ADDRESS <br /> <br />5I5~ Si.ivert~r, kci <br />CITY STATE ZIP <br />Salem Ore on CITY STATE ZIP <br />Sal.em Ore ~r:z <br />CONTACT PHONE <br />~rl? Kurt.". FAX 5$~-7~ ~ ~ CONTACT PHONE <br />FAX <br /> <br />I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ <br />~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I START TIME: ~.1;:~, <br />INITIALS RrB:° am/ <br />m <br />6AM 7 8 9 ~~ ~~ p <br />NOON ~ 2 3 4 5 6 PM <br /> <br />EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING X-TIME NOT CHARGED FINISH TIME: ,~4 ~, <br />` r <br />INI7IALS ~ am/pm <br /> <br />MATfRIALS <br />MATERIAL <br />PACKING <br />UNPACKING <br />AMOUNT • <br />MOYING <br />UNITS <br />RT <br />OT <br />EXT. <br /> QTY. RATE QTY. RATE QTY. RATE 1 TRUCK & DRIVER ~~, 95 ~,~ <br />1 . yf~ <br />BARRELS/DISHPACKS TRUCK & MEN ~~ ~~ ", ~" ~, (" <br />CRATES/CONTAINERS EXTRA LABOR HOURS <br />CARTONS: 1.5 CU FT. ~'~~,' ~~' ~j-q,., t MATERIALS '~ ;;~, ~ <br />3.0 CU FT ` OTHER ~T, ",~;t„ ~" :J Ci <br />4.5 CU FT i K ~ ~.~ f `~, 0:; <br />6.0 CU FT ` <br />WARDROBE CARTON ~ BTOTAL - <br />MIRROR CARTON • • • <br />MATTRESS CTNS: SiNG~E <br />DOUBLE <br />OTHER <br />OTHER: <- , , ~1 ~) <br />~-o"J ' ~ / I <br />SUBT'OTAL -. <br />. • . <br />If the shipper declines to sign this declaration of value and~th~shipm is accepted, <br />the shipment will move at the depreciated value protectiopY I~yel and e sMipper will SUBTOTAI - <br />. . <br />DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTED <br />b@ SUbJ@Ct t0 th@ BPPfOPf18t2 VSIUBtIOft ChBf~Q,~. ~ .~ - <br />^ RELEASED VALUE PROT CTION: SIGNATURE/AGREEMENT TO HIGHER CHARGES DATE SIGNED <br />~ <br />~ <br />Goods will b~ valued at ~cents r Ib. per article. <br />~~ ~~ <br />Shi <br />~ ~ f ' ^ D GROSS W7. TARE WL NET WT. <br />pper. <br />ate: <br />~ ~ ~ ~ MILES: Qa <br />^ DEPRECIATED ~ALUE PRO ION: Goods will be ~lued at $1.25 times the <br />t <br />l <br />i <br />h <br />f <br />h <br />hi <br />F <br />h <br />ac <br />we <br />g <br />ua <br />t o <br />t <br />e s <br />pment. <br />or each $10000, orrtractizln t <br />e-eof, of decla~l value <br />at $125 times the weight of the shipment in Ibs. or de~lared lump sum value, whichever CHARGES FROM ABOVE <br />is higher, the valuat'!on charge shall be 50 cents per each $1.QQQQ,of value. OTyER CH~4RGES <br />Shipper. ` Date- ~~ ~ : <br />, ~ , ~ , ' r i <br />Lump Sum Value: ~ STORAGE CHARGES <br /> <br />^ REPLACEMENT COST PR <br />T VALUATION CHARGES <br />O <br />ECTION: Goods will be valued at $3.50 times the <br />actual weight of the shipment. For each $100.00, or fraction thereof, of declared value <br />at $3S0 times the weight of the shipment in Ibs. or declared lump sum value, whichever <br />i <br />hi <br />h <br />th <br />l <br />i <br />h <br />h <br />ll b <br />TOTAL CHARGES ~ <br />~' <br />~G' '~~ ~,.i <br />g <br />s <br />er, <br />e va <br />on c <br />uat <br />arge s <br />a <br />e 85 cents per each $100.00 of value. ADVANCE DEPOSIT <br />Shipper: Date: <br />i, <br />Lump Sum Value: <br />. . BALANCE DUE~ <br />I acknowledge that I have received, at the first contact with the carrier, a copy of the C.O.D. ~~BILL PREPAID <br />form entitled GENERAL INFORMATION FOR MOVING HOUSEHOLD GOODS OR <br />OFFICES IN OREGON which explains the Oregon rules and regulations affecting <br />intrastate shipments of household goods and office furniture and fixtures. RECEIVED IN GOOD ~ONDIT XCEPT AS NOTED: <br />'}, , ~il~ <br />Consignee: -~;% ~ j"~`": _ <br />I understand that my final charge for service must be based on rates that have been <br />approved by the Public Utility Commission and published in a tariff regardless of any ~- j^~ -~ /I <br />Driver. '' F "~~_ <br />estimate for service provided to me by the carriec I UNDERSTAND THAT AN ESTIMATE <br />IS NOT A FIRM BID. <br />Dated: COMM S/EXCEPTIONS: <br />Shipper: <br />Carrier: <br /> <br />WTB NO. 50 <br />f111n1 ~/~~Tf~ <br />