Interstate Order For Service & Bill of Lading

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:

 Origin Information


Destination Information


Agreed Pick Up Date:

Actual Pick Up Date:

1st Available Delivery Date: 

Delivery No Later than:

Additional Comments & Notes

Payment & Valuation Information

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. For long distance deliveries, Shleppers reserves the right to designate that payment is made to a third party by cash or money order. Credit card and other non cash payments will be charged a 4.5% processing fee.




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   Movebrochure explaining these provisions.

X _________________________ 

(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  

(Customer's Initials)

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” and the "Ready to Move" brochures 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.

Interstate Bill of Lading Terms & Conditions

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:

  • From an act, omission, or order of shipper.
  • From defect or inherent vice of the article, including susceptibility to damage because of atmospheric conditions such as temperature and humidity or changes therein;
  • From acts of God
    • hostile or  warlike  action  in  time  of  peace  or  war,  including  action  in  hindering,  combating  or  defending  against  an  actual,   impending   or   expected   attack   (A)   by   any   government  or   sovereign   power,   or   by   any   authority   maintaining   or   using   military,   naval   or   air   forces;   or   (B)   by   military,   naval   or   air   forces;   or   (C)   by   an   agent   of   any such government, power, authority or forces;
    • any weapon of war employing atomic fission or radioactive force whether in time of peace or war;
    • insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating, or defending against such an occurrence;
    • seizure or destruction under quarantine or customs regulations;
    • confiscation by order of any government or public authority; or
    • risks of contraband or illegal transportation or
  • From terrorist  activity,  including  action   in   hindering   or   defending   against   an   actual   expected   terrorist      Such   loss   or   damage   is   excluded   regardless   of   any   other   cause  or  event  that  contributes  concurrently  or  in  any   sequence   to   the   loss.   The   term   ‘terrorist   activity’   means   any   activity   which   is   unlawful   under   the   laws   of   the   United   States or any State and which involves any of the following:
    • the hijacking or sabotage of any conveyance (including an aircraft, vessel, cab, truck, van, trailer, container or vehicle) or warehouse or other building;
    • the seizing  or  detaining,  and  threatening   to   kill,   injure,   or   continue   to   detain,   another   individual   in   order   to   compel   a   third   person   (including   a   governmental   organization) to do or abstain from doing any act as an explicitly or implicit condition for the release of the individual seized or detained;
    • an assassination;
    • the use  of  any  (A)  biological  agent,   chemical   agent,   or   nuclear   weapon   or   device,   or   (B)   explosive,   firearm,   or   other   weapon   or   dangerous   device   (other   than   for   mere personal monetary gain), with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property; or
    • a threat, attempt, or conspiracy to do any of the
  • From delay  caused  by  strikes,  lockouts,  labor   disturbances,   riots,   civil   commotions,   or   the   acts   of   any   person   or   persons   taking   part   in   any   such   occurrence   or   disorder,   and  from  loss  or  damage  when  carrier,  after  notice  to  shipper  or   consignee   of   a   potential   risk   of   loss   or   damage   to   the   shipment   from   such   causes,   is   instructed   by   the   shipper to proceed with such transportation and/or delivery, notwithstanding such
  • From any  mechanical  or  electrical  malfunction  of  appliances  or   any   electronics   such   as   but   not   limited   to   computers   and   computer   equipment,   piano,   radio,   television   set,  VCR, DVD player, barometer, refrigerator, phonograph, clock, air conditioner or other instrument unless caused and or results of improper handling by its employees.
  • From loss  or  damage  caused  by  ordinary  wear  and   tear,   leakage,   mold,   mildew,   termites,   rodents,   vermin,   moths,   and   other   insects,   rust,   fumigation,   heat,   natural   deterioration, defect of the property, or damage to particle board.
  • From the  loss  or   damage   to   currency,   precious   stones,   documents,   stamps,   securities,   species,   silverware,   jewelry,   personal   electronics   such   as   but   not   limited   to   iPod,   digital  camera,  chargers,  cell  phones,  laptops  or  any  valuables  unless  such  articles  were   specifically   declared   in   writing   prior   to   the   move,   and   unless   the   additional   valuation  charges are paid by the customer.
  • From an  attempt  to  get  a  piece   of   furniture   into   an   area   that   said   piece   has   difficulty   entering   or   exiting      The   damage   to   the   said   piece   and   or   the   property   damage  that  may  occur  as  a  result  to  the  customer’s  request  to   force   items   in   or   out   of   the   residence   or   any   location   where   said   piece   is   to   be   forced   in   or   out,   not   covered  under  carrier’s  liability.  The  customer  at  their  request  will   accept   responsibility   to   any   and   /   or   all   damages   that   may   occur   to   real   property   such   as   but   limited   to   walls, banisters, doorways, floors, ceilings, etc.
  • From packing damage to any fragile items, concealed items or contents unless packed and unpacked by its employees.
  • From the  loss  or  damage  to  a  set  or  pair  of  articles  or  compensation,  repair,   or   replacement   of   a   pair   or   set   of   articles   transported   in   a   shipment,   but   specific   article  damaged or lost while in its possession.

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 lump  sum  value  declared  by  shipper,  which  may  not  be  less  than  $6000.00  or   $6.00   per   pound   multiplied   by   the   actual   weight   of   the      In   pounds,   whichever is greater, or

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 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


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Signature Certificate
Document name: Long Distance Bill of Lading & Agreement (STARTING, w/Universal Entry Form)
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July 29, 2022 6:19 pm PDTLong Distance Bill of Lading & Agreement (STARTING, w/Universal Entry Form) Uploaded by Shleppers Moving & Storage - IP
July 29, 2022 6:26 pm PDTSigned LD STARTING DOCS - added by Shleppers Moving & Storage - as a CC'd Recipient Ip:
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