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Date Ser. Req'd: 3-1$-9] am/pm ~(dk~Y1F.IAL~--- 3-19-97 am~pm Delivery Date Req'd: 3-28-97 am/pm Oroer 7aken By: TOM ~ Ca~~~a~ C~fy Transfer ~ HHG BILL OF LADING t465 JohnSOn Si. NE, Salsm, OR 9730 - B/L Number (503) 581-f,o83 0(800) 828-1641 • fax (503y 581-6924 - PUC ~037342 • !CC MC 227345 J'~ . i~.. ~Y~ '~ '~ 5 . ~ ~ . . f • ' if NAME HUMAN RESOURCES- MARION COUNTY NAME • HUMAN RESOURCES-MARION COUNTY ADDRESS 220 HIGH ST 4th FLOOR ADDRESS CITY STATE ZIP SALEM pR CITY STATE ZIP ~ CONTACT PHONE ELYN LYON FAX CONTACT PHONE FAX ' ~ ~~ `~ - • ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ I ~ ~ ~ I ART TIM : INITIAL ~ p 6AM 7 8 9 ~~ ~~ ~ 2 3 am pm 4 5 6 PM , NOON EXPLANATION: P-PACKING L-LOADING D-DRIVING UL-UNLOADING UP-UNPACKING X-TIME NOT CHARGED FINISHTI INITIALS E: ~~ ~''am/pm MATEFi1ALS MA T~R111L PJACKIN~i IfNPACKING ' AMQUNT • N~YIN4~ ` UtiiTS RT ~'T ~,! ~XT. QTY. RATE QTY. RkTE Q'1'Y. RAT~ 1 TRUCK & DRIVER / BARRELS/DISHPACKS TRUCK & 2 MEN ~ ` / } ~' ". CRATES/CONTAINERS EXTRA LABOR HOURS CARTONS: 1.5 CU FT. SO .OO ~ t" '' MATERIALS f ^"u 3.0 CU FT OTHER j . ~ a ~ ~ 4.5 CU FT ~,~ VZr, :~ ~: e' ! 6.0 CU FT 1 ~:..s ~- ° WARDROBE CARTON - $ ~~~ ~ ~, MIRROR CAfiTON '_ ~ ~ - - MATTRESS CTNS: SiNG~e , -', DOUBLE OTHER -- ~ OTHER: TAPE 5 2. ~, r stickers N C StIB'TOTi4~. 1- . ~-• • • • If the shipper declines to sign this declaration of value and the shipment is accepted, the shipment will move at the depreciated value protection level and the shipper will st~67'Q7'At. '- . ~ ~ . DATE OF PICKUP REQUESTED DATE OF DELIVERY REQUESTED be subject to the appropriate valuation charges. ^ RELEASED VALUE PROTECTION: S~Gt~nTUR~FaGR~htErrr ~ro HiG-tER Ct~aA~ES ' onre Si~Neo ` , _ ~ . . Goods will be valued at 60 cents per Ib. per article. ~ ' I~ 7 J/ Shipper: ~ Date: GI~3S WT. TARE WT. NEf YYI , MILES: @ ^ DEPRECIAT VALUE PROTECTION: Goods will be valued at $1.25 times the actual weight of the shi ment For each $100 00 or fracti th f f d l d l p . . , on ereo , o ec are va ue at $1.25 times the weight of the shipment in Ibs. or declared lump sum value, whichever CHARGES FROM ABOVE is higher, the valuation charge shall,pe 50 cents per each $100.00 of value. ! OTHER CHARGES Shipper: Date: Lump Sum Value: STORAGE CHARGES ^ REPLACEMENT COST PROTEC'TION: Go d ill b l d 3 i VALUATION CHARGES o s w e va ue at $ .50 t mes the actual weight of the shipment. For each $100.00, or fraction thereof, of declared value at $3.50 times the weight of the shipment in Ibs. or declared lump sum value, whichever is higher the valuation char e shall be 85 cent r h $100 00 f l ~ ~ Tt'~IKL CHARGES ~ : ,~~ ~ , g s pe eac . va o ue. ADVANCE DEPOSIT Shipper: Date: ~ump Sum Value: . • ~4LAWCE ~Uf ~= ~ ~~ I acknowledge that I have received, at the first contact with the carrier, a copy of the C.O.D. BILL PR EPAID ~ form entitled GENERAL INFORMATION FOR MOVING HOUSEHOLD GOODS OR OFFICES IN OREGON which explains the Oregon rules and regulations affecting intrastate shipments of household goods and office fumiture and fixtures. RECEIVED IN GOOD!,C ITIOM EXC~PT AS NOTED: ~? - '-r" ~ Consignee: f~ ~`. ~- ~ yf ~ ~'-~ I understand that my final charge for service must be based on rates that have been approved by the Public Utiliry Commission and published in a tariff regardless of any /: ;.. _ • Driver. ~ `' ~~~ ~/` estimate for service provided to me by the carrier. I UNDERSTAND THAT AN ESTIMATE IS NOT A FIRM BID. Dated: COMMENTS/ EXCEPTIONS: _ Shipper: Carrier. wre No. so