SHIPPER
DECLARATION OF VALUE
IMPORTANT:
There
are two (2) options available to cover loss and/or damages:
OPTION
1:
Actual cash value. This option provides for reimbursement for loss or
damage NOT
EXCEEDING Three Hundred Dollars ($300.00) dollars PER MOVE, based on the
Deprecation value at the time of the loss or damage. This option
is included in the
Transportation and there is no addition CHARGE. Should your goods be
involved
in a catastrophe such as a fire, accident or any other nature, the
Carrier shall have
the
option of repairing and or restoring the original condition.
OPTION
2:
Full Value Protection. This option provides coverage based on current replacement
value at the time of loss or damage, up to the dollar amount of valuation declared
by you (SEE NOTE). The cost is based on the actual value of the goods,
and the
Deductible, if any, declared by you. Carrier shall have the option of repairing and
or restoring to the original condition.
**DECLARATION**
Prior
to the move the shipper must select one of the options listed below. If shipper
refuses to select on of these options, the carrier will not be required to
perform the move.
Shipper
herby releases the entire shipment to a value not exceeding:
___________________________ Option
1- (Depreciated Value) -$300.00 per move
SIGNATURE
OF SHIPPER AND DATE
based
on depreciation value at no additional charge.
___________________________
Option 2(a)- (REPLACEMENT VALUE)-(See Note)
SIGNATURE
OF SHIPPER AND DATE
$
with no deduction at a charge $11.30 per
thousand ($1,000) of declared value. This would result in an
additional charge of $________________.
____________________________
Option 2(b)- (REPLACEMENT VALUE)-(See Note)
SIGNATURE
OF SHIPPER AND DATE
$______________
with a $300.00 deduction at a charge
$3.75 per thousand ($1,000) of declared value. This would
result in an additional charge of $___________________.
NOTE:
Must be an amount equal to or exceeding $5,000 per room excluding halls, attics,
garage, closets, bath. A self-storage unit will constitute a room.
This
document shall be completed and signed PRIOR TO MOVE and made a permanent
part
of the Bill of Lading.
If
carrier Fails to require shipper to choose one of the above Liability Option,
the shipper will considered
have chosen 2(a) (Replacement Value, no deductible) at no charge to shipper.
BILL OF LADING/ORDER NO:_________________________ DATE:______________________
NAME OF SHIPPER _____________________________________________________________
( ) HOURLY RATED MOVE ( ) WEIGHT & DISTANCE MOVE
CARRIER REPRESENTATIVE:______________________________________________________