Legal Shipper Inventory Form

LEGAL SHIPPER INVENTORY FORM

This Legal Shipper Inventory Form (the "Form") is made effective as of Date: by and between Shipper Name: ("Shipper") and Carrier Name: ("Carrier").

RECITALS

WHEREAS, Shipper intends to deliver certain goods, chattels, and packages described herein for carriage, handling and delivery by Carrier pursuant to the terms of this Form; and

WHEREAS, Carrier is engaged in the business of transporting goods and has represented that it has the necessary equipment, personnel, and insurance to receive, secure, transport and deliver the goods; and

WHEREAS, the parties desire to record a detailed inventory and to set forth certain terms and conditions governing carriage, liability, and claims in respect of the goods described below.

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, the following terms shall have the meanings set forth below. "Goods" means the items listed in Section 2. "Inventory" means the detailed description, quantity, condition and declared value as recorded on this Form. "Delivery" means physical transfer of custody to the Consignee identified on the Bill of Lading or delivery receipt.

2. INVENTORY DESCRIPTION

Shipment Reference/BOL No.: Origin: Destination:

Carrier Equipment/Trailer No.: Number of Packages/Pieces: Total Weight (lbs):

Contains Hazardous Materials: Special Handling Required:

The Inventory of Goods is set forth in the itemized entries below. Each line must be completed by Shipper at time of tender.

3. CONDITION ON RECEIPT; INSPECTION

Carrier shall inspect visible condition of packaging at the time of receipt and note any visible damage on the shipment receipt. Unless Shipper provides written notice to Carrier of concealed loss or damage within calendar days after delivery, the Goods shall be deemed accepted in the condition received. All claims must identify the specific Inventory line(s) and describe the nature of the alleged loss or damage.

4. LIABILITY AND LIMITATION

Carrier's liability for loss, damage or delay shall be limited to the declared value for each item as stated in Section 2, except where loss or damage results from Carrier's gross negligence or willful misconduct. Carrier shall not be liable for consequential, incidental, or punitive damages, nor for ordinary wear and tear, inherent vice, or inadequate packaging by Shipper.

Declared Value Per Shipment:

5. INSURANCE

Carrier represents that it will maintain cargo and liability insurance in commercially reasonable amounts and shall, upon request, furnish certificates of insurance evidencing coverages applicable to the carriage of the Goods. Insurance does not limit Carrier's obligations under this Form.

6. INDEMNIFICATION

Each party (the "Indemnitor") shall indemnify, defend and hold harmless the other party and its officers, agents and employees from and against any and all claims, liabilities, losses, damages and expenses (including reasonable attorneys' fees) arising from the Indemnitor's negligence, breach of this Form, reckless or willful acts, or failure to comply with applicable laws in connection with the Goods.

7. CONFIDENTIALITY

The parties agree to maintain in confidence any non-public commercial information disclosed in connection with this Form, including declared values, special handling instructions, and the Inventory, and shall not disclose such information except to comply with legal process or to effectuate transportation and claims handling.

8. NOTICES

Notices shall be in writing and shall be deemed given when delivered in person, sent by nationally recognized overnight courier, or three (3) business days after deposit in the mail, postage prepaid, to the addresses above.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This Form may be amended only by a written instrument signed by both parties. No waiver of any provision shall be effective unless in writing and signed by the waiving party. This Form may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

10. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Form shall be governed by and construed in accordance with the laws of the State of , exclusive of its conflicts of law rules. If any provision of this Form is held unenforceable, the remaining provisions shall remain in full force and effect. This Form, together with any referenced bills of lading and shipping documents signed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof.

11. ADDITIONAL REMARKS

CERTIFICATIONS

Shipper certifies that (a) the Inventory is true and correct to the best of Shipper's knowledge; (b) packaging is adequate for normal carriage unless otherwise specified in writing; and (c) all declarations concerning hazardous materials are accurate and in compliance with applicable law. Carrier acknowledges receipt of the Goods as described above and agrees to handle the Goods consistent with the terms of this Form.

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