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Inventory Form

Owner: Origin:
Load Date: Destination:

Article Est

Value
1. Living Room
Coffee/End Tables

Sofa/ Chairs

Drapes
Other Furniture
Pictures
Paintings
Carpets
Lamps
Prints
Grandfather Clock
Piano/Organ
Other
Total 1

Article Est

Value
2. Dining Room

Furniture

Carpets
Drapes
Other
Total 2

Article Est

Value
3. Kitchen

Furniture

Small Appliances

Major Appliances

Washer/Dryer

Dishes

Pots & Pans

Utensils

Vacuum Cleaner

Microwave

Food

Other

Total 3

ArticleEst

Value
4. China & Glassware

Silver

China
Glassware
Other
Total 4

ArticleEst

Value
5. Bedrooms  

Master

#2
#3
#4
Office
Pictures/mirrors
Carpets/rugs
Lamps
Drapes
Other
Total 5

ArticleEst

Value
6. Linen and Clothing

Men's

Ladies'
Children's
Footwear
Coats
Linen
Bedding
Towels
Other
Total 6

ArticleEst

Value
7. Family Room
Furniture
Carpets
Exercise Equipment
Pool Table
Drapes
Other
Total 7

ArticleEst

Value
8. Basement

Furniture

Carpets
Other
Total 8

ArticleEst

Value

9. Electronics

TV's

Stereos
Speakers
Radios
Cameras
Video Camera
Video Cassettes
Tapes/CD's
VCR/DVD
Computers
Other
Total 9

ArticleEst

Value
10. High Value Items

Furniture

Art Work
Antiques
Collectibles
Other
Please provide full description of all High Value Items including value in the Comment section below
Total 10

ArticleEst

Value
11. Motorized Items

Vehicle #1

Vehicle #2
Trailers
Snowmobiles
Motorcycles
Boats
Motors
Other
Please provide vehicle details including year, make, model in the Comment section below
Total 11

ArticleEst

Value
12. Miscellaneous

Clocks

Knick Knacks
Figurines
Books
Luggage
Tools
Xmas Decorations
Floral Arrangements
Sewing Supplies
Golf Clubs
Bicycles
Garden Equipment
Patio Equipment
Sporting Goods
Lawn Mowers
Snow blower
Fishing Gear
Other
Total 12
 
Additional comments:
   
 
A. Total Value ( 1+2+3+4+5+6+7+8+9+10+11+12)
 

CONDITIONS OF CARRIAGE

The settlement of a claim is subject to the Conditions of Carriage of the Bill of Lading as follows:

This Certificate does not cover:

a) Loss, damage or delay to any of the goods described in the Bill of Lading caused by an act of god, the Queen's or public enemies, riots, a defect or inherent vice in the goods, the act of default of the consignor, owner or consignee, authority of law or quarantine.

b) Other than because of his, his agent's or employee's negligence

i) Damage to fragile articles that are not packed and unpacked by the contracting carrier, his agent or employees.

ii)Damage to the mechanical, electronic, or other operations of radios, phonographs, computers, clocks, appliances, musical instruments and other equipment, irrespective of who packed or unpacked such articles, unless servicing and preparation was performed by the contracting carrier, his agent or employees.

iii) Deterioration of or damage to perishable food, plants, or pets.

iv) Loss of contents of consignor-packed articles, unless the containers used are opened for the carrier's inspection and articles are listed on the Bill of Lading and receipted for by the carrier.

Burden of proving absence of such negligence shall be on the carrier.

c)Damage to or loss of a complete set or unit when only part of such set is damaged or lost, in which event the carrier shall be liable for repair or recovering of the lost or damaged piece or pieces.

d) Damage to the goods at place or places of pickup at which the consignor or his agent is not in attendance.

e) Damage to the goods at place or places of delivery at which the consignee or his agent in is not in attendance and cannot give receipt for goods delivered.

Articles of Extraordinary Value

No carrier is bound to carry any documents, species, or any articles of extraordinary value unless by a special agreement to do so. If such goods are carried without a special agreement and the nature of the goods is not disclosed on the face of the Bill of Lading, the carrier shall not be liable for any loss or damage.

Article 9 - Valuation

Subject to Article 10, the amount of any loss or damage for which the carrier shall be liable, whether or not the loss or damage results from negligence of the carrier or its employees or agents, shall be computed on the basis of the value of the lost or damaged articles(s) at the time and place of shipment.

Article 10 - Maximum Liability

a) The amount of any loss or damage computed under Article 9 shall not exceed the greater of:

i) the value declared by the shipper; or

ii) $10.00 per pound computed on the total weight of the shipment, provided that, where the consignor releases the shipment to a value of $.060 per pound per article or less in writing, the amount of any loss or damage computed under Article 9 shall not exceed such lower amount.

b)Where clause i) or ii) applies, additional charges to cover the additional coverage over $0.60 per pound per article shall be paid by the consignor.

To purchase Replacement Value Protection, this form must be completed and be returned to your QMM Customer Service Manager at least 48 hrs prior to the move

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