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Received and m ut ually agreed by t he shipper and his assigns, any addit ional part y w it h an int erest t o any of said

Ca rrier lia bilit y in t he 4 8 cont iguous st a t es only: Shipm ent s va lued a t m ore t ha n $ 2 0 .0 0 per pound

propert y heret o and each carrier of all or any of said propert y over all or any port ion of said rout e t o dest inat ion,

a re of ex t ra ordina ry va lue . Ca rrier’s m a x im um lia bilit y is $ 2 0 .0 0 per pound per pa ck a ge subj ect t o

t hat every service t o be perform ed hereunder shall be subj ect t o t he N at ional Mot or Freight classificat ions

$ 5 0 ,0 0 0 .0 0 m a x im um t ot a l lia bilit y per occurrence . The a greed va lue on household goods, used

( N MF 1 0 0 Series) including t he Rules, packaging and t he Uniform Bill of Lading Term s and Condit ions, t he

m a chinery, or persona l effect s does not ex ceed t en cent s per pound per a rt icle, unless ot herw ise

applicable regulat ions of t he US Depart m ent of Transport at ion ( DOT) , t he ATA Hazardous Mat erials Rules Guide

specified.

Book, t he Household Goods Mileage Guides, t he Carrier’s t ariffs, t he Carrier’s pricing schedules, t erm s, condit ions

and rules m aint ained at Carrier’s general offices all of w hich are in effect as of t he dat e of issue of t his Bill of

ACCESSORIAL SERVICES REQUESTED -

Hover over for full description

Ins. Amount

Lading. Shipper cert ifies t hat t he consigned m erchandise is properly w eighed, classified, described, packaged,

ARN

CA

HYD

IDC

IND

m arked, labeled, dest ined as indicat ed, in apparent good order except as not ed ( cont ent s and condit ions of

cont ent s of packages unknow n) , and in proper condit ion for t ransport at ion according t o t he DOT and t he N MF 1 0 0

Series. Carrier ( Carrier being underst ood t hroughout t his cont ract as m eaning any person or corporat ion in

OVL

OV2

TRS

RDC

possession of t he propert y under t his cont ract ) agrees t o carry t o said dest inat ion if on it s rout e, ot herw ise t o

deliver t o anot her carrier on t he rout e t o said dest inat ion . Carrier shall in no event be liable for loss of profit ,

incom e, int erest , at t orney fees, or any special, incident al or consequent ial dam ages.

Note: Items excluded from coverage include used articles, household goods, personal effects,

N OTE- W he r e t he r a t e is de pe nde nt on va lue , shippe r s a r e r e quir e d t o st a t e spe cifica lly in

and other prohibited commodities shown in OD Rules 100,Item 780. Maximum liability shall not

w r it ing t he a gr e e d or de cla r e d va lue of t he pr ope r t y .

exceed $250,000.00 and shipments must be prepaid. See OD Rules 100, Item 574 for complete

The a greed or decla red va lue of t he propert y is hereby specifica lly st a t ed by t he shipper t o be not ex ceeding

rules on Insurance - truck conveyed freight.

$ _____________________ per __________________________

SHIPPER:

DATE:

H/U RECEIVED:

TRAILER NO.:

AUTHORIZED SIGNATURE: (Shipper)

CARRIER: OLD DOMINION FREIGHT LINE, INC.

AUTHORIZED SIGNATURE: (Driver)