UNITED VAN LINES, LLC

1 UNITED DRIVE

FENTON, MO  63026

PHONE (636) 326-3100

 

HIGH VALUE INVENTORY

INVENTORY OF ITEMS VALUED IN EXCESS OF $100 PER POUND PER ARTICLE

 

I C C NO. 67234

DOT # 77949

 

CARRIER BILL OF LADING NO.

 
         
  

ALL ITEMS INCLUDED IN YOUR SHIPMENT THAT ARE CONSIDERED TO BE OF EXTRAORDINARY (UNUSUAL) VALUE MUST BE SPECIFICALLY IDENTIFIED AND THE CARRIER MUST BE ADVISED THAT THEY ARE INCLUDED IN THE SHIPMENT.  ITEMS OF EXTRAORDINARY VALUE ARE DEFINED AS THOSE HAVING A VALUE GREATER THAN $100 PER POUND.  TYPICAL HOUSEHOLD GOODS ITEMS THAT FREQUENTLY HAVE A VALUE IN EXCESS OF $100 PER POUND PER ARTICLE ARE:  CURRENCY, COINS, JEWELRY, PRECIOUS METALS, PRECIOUS OR SEMI-PRECIOUS STONES OR GEMS, GOLD, SILVER OR PLATINUM ARTICLES INCLUDING SILVERWARE AND SERVICE SETS, CHINA SETS, CRYSTAL OR FIGURINES, FUR OR FUR GARMENTS, ANTIQUES, ORIENTAL RUGS OR TAPESTRIES, RARE COLLECTIBLE ITEMS OR OBJECTS OF ART, COMPUTER SOFTWARE PROGRAMS, MANUSCRIPTS OR OTHER RARE DOCUMENTS.  OF COURSE, OTHER ITEMS MAY ALSO FALL INTO THIS CATEGORY AND MUST BE IDENTIFIED AS WELL.

THE PURPOSE OF THIS INVENTORY IS TO ASSIST YOU IN IDENTIFYING ARTICLES OF EXTRAORDINARY OR UNUSUAL VALUE IN ORDER THAT THE CARRIER WILL BE AWARE OF THOSE ITEMS WHICH REQUIRE SPECIAL HANDLING AND PROTECTION.  FAILURE TO IDENTIFY SUCH ARTICLES WILL RESULT IN LIMITED CARRIER LIABILITY.

   

List

No.

Inventory

Number

Description of Articles Exceeding $100 Per Pound Per Article

List

No.

Inventory

Number

Description of Articles Exceeding $100 Per Pound Per Article

1.     8.    
2.     9.    
3.     10.    
4.     11.    
5.     12.    
6.     13.    
7.     14.    

OWNER (SHIPPER) AGREES THAT ANY CLAIM FOR LOSS OR DAMAGE MUST BE SUPPORTED BY PROOF OF VALUE AND UNDERSTANDS SETTLEMENT WILL BE BASED UPON THE INFORMATION FURNISHED ON THIS INVENTORY FORM AND THE DECLARATION OF VALUE CONTAINED ON THE ACCOMPANYING BILL OF LADING, THE BILL OF LADING TERMS AND CONDITIONS, THE TARIFF IN EFFECT AT THE TIME OF SHIPMENT, THE HOUSEHOLD GOODS DESCRIPTIVE INVENTORY, AND ALL OTHER PERTINENT INFORMATION AVAILABLE TO THE CARRIER.  IF YOU HAVE NOT LISTED ARTICLES HAVING A VALUE IN EXCESS OF $100 PER POUND PER ARTICLE ON THIS INVENTORY, YOUR SIGNATURE BELOW ATTESTS TO THE FACT THAT SUCH ARTICLES ARE NOT INCLUDED IN YOUR SHIPMENT.  IF THROUGH INADVERTENCE OR ANY OTHER CAUSE, ITEMS HAVING A VALUE IN EXCESS OF $100 PER POUND PER ARTICLE ARE INCLUDED IN YOUR SHIPMENT AND YOU FAIL TO LIST THOSE ITEMS IN THE INVENTORY, OR FAIL TO SIGN THIS INVENTORY, YOU EXPRESSLY AGREE THAT THE CARRIER'S LIABILITY FOR LOSS OR DAMAGE TO THOSE ITEMS WILL BE LIMITED TO NO MORE THAN $100 PER POUND PER ARTICLE (BASED UPON THE ACTUAL ARTICLE WEIGHT).

AT ORIGIN

I certify the above listed information

to be true, correct and complete.

 

AT DESTINATION

I acknowledge receipt of the above listed items with exception only as noted on the carriers descriptive inventory.

X
 
X

Signature of Owner (Shipper) or

Owner's (Shipper's) Representative

Date
 

Signature of Owner (Shipper) or

Owner's (Shipper's) Representative

Date
     

Carrier's representative acknowledges receipt

of an executed copy of this inventory

 

Carrier's representative acknowledges delivery

of the above listed items

X
 
X

Signature of Carrier's

Representative

Date
 

Signature of Carrier's

Representative

Date
     
 
   
Shipment Origin (City and State)