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® • • • • • • 1 • 9 • • • -* • Copyright 2017 J.J.Keller&Associates,Inc.•Neenah,WI•JJKeller.com•(800)327.6868•Printed in the USA • • I IT,Fit STRAIGHT BILL OF LADING-ORIGINAL-NOT NEGOTIABLE Shipper's No. Carrier SCAC Carrier's No. TM RECEIVED,subject to individually determined rates contracts that have been agreed upon in writing between the carrier and shipper,it applicable,otherwise to the rates,classifications and rules that have been established by the carrier and are available to the shl per,on request;and all applicable state and federal regulations; at date from the Property described below,in apparent good order,except as noted(contents and condition of contents of packages unknown),marked,consigned,and destined as indicated below,which said company (the word company being understood throughout this contract as meaning any person or corporation in possession of the property under the contract)agrees to carry to delivery at said destination,if on its route,or otherwise to deliver to another carrier on the route to said destination.It is mutually agreed as to each carrier of all or any of said Property over all or any portion of said route to destination,and as to each party at any time interested in all or any of said Property that every service to be performed hereunder shall be subject to all the conditions not prohibited by law,whether printed or written,herein contained,including the conditions on the back hereof,which are hereby agreed to by the shipper and accepted for himself and his assigns. TO: FROM: Consignee ( ' ier L,64 �H� � Il 6 Street4-it • Street OD W' 0 /1 `� Destination I Zi / Origin r CA Zi Route Tem—"Ge- Delivering Carrier ��n �i nn� Vehicle Number U.S. DOT Hazmat Reg. No. Type . I umber and of Description I e X` OA __- — ----- ------- e %ni- Remit COD t0: Sublact 10 Sade ,of conditions,N this COD COD FEE. shipment is to be delivered to the consignee (v" AMT: without recourse on the consignor, the Address: Ana e'er shallsignad�totllmaakeeder statement: this Prepaid ❑ City: State: Zi shipment without payment of freight and all Collect ❑ othat lawful charges. NOTE.Where the rate is dependent on value,shippers are required to stale specifically in writing TOTAL CHARGES: FREIGHT CHARGES: Me agreed or declared value of the property The agreed or declared value of the property is Q hereby specifically stated by the shipper to be not exceeding $ Per si nawre of Consi nor $ ❑ Prepaid ❑Collect NOTE:Liability Limitation for loss or damage In this shipment may be applicable.See 49 U.S.C. •. 147 c 1 A and 6. .. s ❑BY SHIPPER ❑BY CARRIER I,,;;:,to candy u.al a-,e above-named materials are properly classified,described,packaged, m>/.uU and Iabeied and are,n proper a xJdwn for Vansponation according to tt applicable � • DRIVER'S ,ngdaltrr�a W du:Gcl. w ,-ni of r.,po �Inxf' SI NATURE: SHIPPER: -- CARRIER: PER: DATE: — PER: DATE: EME GENCY RESPONSE NAME OR CONTRACT NUMBER rcl colannlr` �u f11AC�f=[7• f1R(1THFR I INIf�11F IIIFNT)FIFR•