Carrier Information: Civic Van Lines, Inc. DBA Shleppers Moving & Storage, DOT: 2306227, MC: 787354
Shipper Name: Move Date: JOB#:
Price: Estimated Cubic Feet: Rate per Cubic Foot:
Agreed Pick Up Date:
Actual Pick Up Date:
1st Available Delivery Date:
Delivery No Later than:
METHOD OF PAYMENT: You will be charged 50% of the cost of the move on the first day of your moving service. The balance will be charged upon your items shipping for delivery.
THE CUSTOMER MUST SELECT ONE OF THESE OPTIONS FOR THE CARRIER'S LIABILITY FOR LOSS OR DAMAGE TO YOUR HOUSEHOLD GOODS
CUSTOMER'S DECLARATION of VALUE
THIS IS A TARIFF LEVEL OF CARRIER LIABILITY - IT IS NOT INSURANCE
OPTION 1: The Cost Estimate that you receive from your mover MUST INCLUDE Full (Replacement) Value Protection for the articles that are included in your shipment. If you wish to waive the Full (Replacement) Level of protection you must complete the WAIVER of Full (Replacement) Value Protection shown below.
Full (Replacement) Value Protection is the most comprehensive plan available for protection of your goods. If any article is lost, destroyed or damaged while in your mover's custody, your mover will, at its option, either 1) repair the article to the extent necessary to restore it to the same condition as when it was received by your mover, or pay you for the cost of such repairs; or 2) replace the article with an article of like kind and quality, or pay you for the cost of such a replacement. Under Full (Replacement) Value Protection, if you do not declare a higher replacement value on this form prior to the time of shipment, the value of your goods will be deemed to be equal to $6.00 multiplied by the weight (in pounds) of the shipment, subject to a minimum valuation for the shipment of $6000. Under this option the cost of your move will be composed of a base rate plus an added cost reflecting the cost of providing this full value cargo liability protection for your shipment.
If you wish to declare a higher value for your shipment than these default amounts, you must indicate that value here. Declaring a higher value may increase the valuation charge in your cost estimate.
The Total Value of my shipment is:
$______________________(to be provided by the customer)
Dollar Estimate of the cost of your move at Full (Replacement) Value Protection:
$ ______________________(to be provided by carrier)
I acknowledge that for my shipment I have 1) ACCEPTED the Full (Replacement) Level of protection included in the estimate and declared a higher total value of my shipment (if appropriate); and 2) received a copy of the “Your Rights and Responsibilities When You Move” brochure explaining these provisions.
(Customer's Signature & Date)
Option 2 - WAIVER of Full (Replacement) Value Protection. This lower level of protection is provided at no additional cost beyond the base rate; however, it provides only minimal protection that is considerably less than the average value of household goods. Under this option, a claim for any article that may be lost, destroyed or damaged while in your mover's custody will be settled based on the weight of the individual article multiplied by .60 cents. For example, the settlement for an audio component valued at $1000 that weighs 10 pounds would be $6.00 (10 pounds times 60¢).
Dollar Estimate of the cost of your move under the 60-cents option:
$ _______________________(to be provided by carrier)
COMPLETE THIS PART ONLY if you wish to WAIVE the Full (Replacement) Level of Protection included in the higher cost estimate provided (above) (on the prior page) for your shipment and instead select the LOWER Released Value of 60 Cents Per Pound Per Article; to do so you must initial and sign on the lines below - I wish to Release My Shipment to a Maximum Value of 60 Cents per Pound per Article
I acknowledge that for my shipment I have 1) WAIVED the Full (Replacement) Level of protection for which I have received an estimate of charges; and 2) received a copy of the “Your Rights and Responsibilities When You Move” brochure explaining these provisions.
X (Customer's Signature & Date)
DECLARATION OF ARICLE(S) OF EXTRAORDINARY (UNUSUAL) VALUE - I acknowledge that I have prepared and retained a copy of the "Inventory of Items Valued in Excess of $100 Per Pound per Article" that are included in my shipment and that I have given a copy of this Inventory to the mover's representative. I also acknowledge that the mover's liability for loss of or damage to any article valued in excess of $100 per pound will be limited to $100 per pound for each pound of such lost or damaged article(s) (based on actual article weight), not to exceed the declared value of the entire shipment, unless I have specifically identified such articles for which a claim for loss or damage may be made on the attached inventory.
X (Customer's Signature & Date)
METHOD OF CONVERSION: Non-Binding Estimates will be calculated by the actual weight of a shipment supported by weight tickets. Binding Estimates will be calculated by utilizing the mandatory conversion formula of the actual cubic feet multiplied by 7.
TARIFF AVAILABILITY: Carriers Tariff, by reference, is made a part of the Bill of Lading and is available for inspection at the carrier’s facility. Carrier may furnish a copy of provisions of the tariff governing this shipment upon request.
DOCUMENTS: I hereby declare that I have received the following booklets & brochures: Ready to Move Booklet; Claim Filing Information Brochure
Arbitration Program Brochure.
PICK UP ACKNOWLEDGEMENT: I, the shipper / representative, hereby declare that I have the full authority to enter into this agreement with the carrier / its agents and that I will be responsible severally or jointly for the charges applied and listed above. I understand that all charges are based on the actual weight or space occupied by my shipment. I agree and
accept the charges as listed above.
Except when transportation is performed under the provisions of item 2(a) of the tariff, the following Bill of Lading Terms and Conditions apply to all transportation performed by carrier in addition and conjunction with all other rules, regulations, rates, and charges in this applicable tariff, which is available for inspection at the facility (s) specified by the carrier. Carrier may furnish provisions of the tariff governing this shipment upon request. This contract is subject to all the rules, regulations, rates, and charges in the carrier’s currently effective applicable tariffs including, but not limited to, the following terms and conditions:
SECTION 1: LIMITATION OF LIABILITY. The carrier or party in possession shall be liable for physical loss of or damage to any articles from external cause while being carried EXCEPT loss, damage or delay caused by or resulting:
SUBJECT, in addition to the foregoing, to the further following limitations on the carrier’s or the party’s in possession liability: The carrier’s or the party’s in possession maximum liability shall be:
The actual loss or damage not exceeding sixty (60) cents per pound of the weight of any lost or damaged article when the shipper has released the shipment to carrier, in writing, with the maximum liability limited to sixty (60) cents per pound per article.
SECTION 2: DELAY OF DELIVERY. The carrier shall not be liable for delay caused by highway obstruction, or faulty or impassable highways, or lack of capacity of any highway, bridge or ferry, or caused by breakdown or mechanical defect of vehicles or equipment, or from any cause other than negligence of the carrier; nor shall the carrier be bound to transport by any particular schedule, means, vehicle or otherwise than with reasonable dispatch. Every carrier shall have the right in case of physical necessity to forward said property by any carrier or route between the point of shipment and the point of destination.
SECTION 3: DELIVERY TO STORAGE. If for any reason other than the fault of the carrier, delivery cannot be made at address shown on the face hereof, or at any previously agreed upon changed address, carrier, at its sole discretion, may place said shipments in storage in a warehouse selected by it at the point of delivery or at any other available points, at the cost of the owner, and subject to a lien for all accrued tariff charges. If after shipment is placed in storage, the shipper elects to pay all balances due to carrier, the carrier may elect to deliver said shipment and collect all applicable tariff charges at time of delivery or prior to attempting second delivery; if storage is located near shippers destination address as listed on the face hereof, the carrier may release the goods to the shipper at the storage location in which the delivery was made.
SECTION 4: DELIVERY SCHEDULE. The carrier shall attempt delivery within the time frame allowed per the carrier’s applicable tariff as indicated in the carrier’s delivery Zone & Schedule Table. If shipment is delayed at the fault of the carrier, the compensation for such delay will be calculated at $30.00 per each day of delay at pick up or $30.00 per each day of delay of delivery.
SECTION 5: COLLECTION OF CHARGES. Upon arrival at origin location 50% of the balance must be paid by: Certified Check, Postal Money Order, Cash, or Credit Card. The remaining balance must be paid in full prior to the unloading of the truck at destination by Certified Check, Postal Money Order, Cash, or Credit card. We accept most credit cards. The carrier reserves the right to collect 15% of all charges due in addition to the 100% of a binding estimate or 110% of a non binding estimate if impracticable operations are required at time of delivery. Shleppers may also require, at its sole discretion, whatever form of payment it designates and may choose not to accept credit payments.
SECTION 6: PAYMENT FOR SERVICES / INDEMNITY OF DAMAGE. (a) The shipper, upon tender of the shipment to carrier, and the consignee, upon acceptance of delivery of shipment from carrier, shall be liable, jointly and severally, for all unpaid charges payable on account of a shipment in accordance with applicable tariffs including, but not limited to, sums advanced or disbursed by a carrier on account of such shipment. The extension of credit to either shipper or consignee for such unpaid charges shall not thereby discharge the obligation of the other party to pay such charges in the event the party to whom credit has been extended shall fail to pay such charges. (b) The shipper shall indemnify carrier against loss or damage caused by inclusion in the shipment of explosives or dangerous articles or goods.
SECTION 7: AUCTION OF SHIPMENT. If shipment is refused by consignee at destination, or if shipper, consignee or owner of property fails to receive or claim it within fifteen (15) days after written notice by United States mail addressed to shipper and consignee at post office addresses shown on face thereof, or if shipper fails or refuses to pay applicable charges in accordance with carrier’s applicable tariff, carrier may sell the property at its option, either (a) upon notice in the manner authorized by law, or given in writing.
(b) at public auction to highest bidder for cash at a public sale to be held at a time and place named by carrier, thirty (30) days notice of which sale shall have been given in writing to shipper and consignee, and there shall have been published at least once a week for two consecutive weeks in a newspaper of genera] circulation at or near the place of sale, a notice thereof containing a description of the property as described in the bill of lading, and the names of the consignor and consignee. The proceeds of any sale shall be applied toward payment of tariff charges applicable to shipment and toward expenses of notice, advertising and sale, and of storing, caring for and maintaining property prior to sale, and the balance if any shall be paid to owner of property; PROVIDED that any perishable articles contained in said shipment may be sold at public or private sale without such notices, if, in the opinion of carrier, such action is necessary to prevent deterioration or further deterioration.
SECTION 8: SECTION 8: FILING OF CLAIMS. As a condition precedent to recovery, a claim for loss, damage, delay, overcharge or property damage must be filed in writing within nine (9) months after delivery to consignee as shown on the governing Bill of Lading, or in case of failure to make delivery, within nine (9) months after a reasonable time for delivery has elapsed; Per federal law the carrier must participate in Arbitration Program and offer this option to a shipper when a settlement cannot be reached. The carrier participates in the Arbitration Program provided by AMSA 703-683-7410 Where a claim is not filed or suit is not instituted thereon in accordance with the foregoing provisions, carrier shall not be liable and such a claim will not be paid. All claims are subject to the full payment of services rendered by shipper.
SECTION 9: LAW, VENUE AND JURISDICTION. If a situation arises in which a settlement cannot be reached or a dispute between carrier and shipper cannot be resolved, the shipper hereby agrees to the jurisdiction of Los Angeles, CA and waives the right to be served within Los Angeles, CA. Suit must be instituted within two (2) years and one (1) day from the date the carrier notifies the shipper that the claim or any parts thereof have been disallowed. Suits involving disputes resulting of interstate relocation must be limited to the governing federal regulations. Shipper may only bring suit in circuit or county court in and for Los Angeles, CA. Both parties consent to and agree given the relationship to the state, such an exercise is reasonable and lawful. Shipper also agrees that if the company offers to have a dispute mediated, the shipper will and must accept such mediation prior to litigation. If the Company prevails in court action, the shipper shall be responsible to reimburse the Company for all the legal fees and other associated court and defense costs incurred in defense of the matter.
SECTION 10: CANCELLATION OF SERVICES. The carrier has the right to cancel services ordered by the shipper at its sole discretion subject to the complete refund of prepaid deposits. EXCEPT When the shipper has notified the carrier in writing via e-mail up to 48 hours prior to the scheduled pick up date. Cancellation notice must be sent to email@example.com for a complete refund of prepaid deposits. Unless a cancellation notice has been received as instructed herein the deposit will not be refundable and cancellation charges shall become due and payable.
SECTION 11: JEWELRY, CASH AND HIGH PRICE COLLECTIBLES. Carrier/The Company will not carry and/or be liable in any way for the loss or damage to currency, precious stones, documents, stamps, securities, or jewelry. Any items of extreme value should be moved separately by the customer.
I affirm the Terms & Conditions above and accept the carrier's limits of liability. In the event I suffer losses or damages to my shipment, I will not be allowed to file a chargeback and agree to file a claim and/or adhere to the arbitration clause set forth herein. I Understand & Agree Agree
END PICKUP JOB CLOSING ENTRY FORM CAN BE FOUND HERE:
DELIVERY CONFIRMATION ENTRY FORM CAN BE FOUND HERE:
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Your legal name
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Interstate Order For Service & BOL (W/ Entry Form)
Agree & Sign