No: 50? aggagqotl.

REJECTED

SSG ELI CASTELLANO
NCOIC

Signature/Date: A/m/ 0,20
Witness Signature/Date: 9?0


PER: ADIUDENT GENERAL OF NEW MEXICO

BILL OF LADING

SKIPPER
MD 3PL
821 ROCKEFELLER AVE
ONTARIO. CA 91761

Jeffrey Pollack. 216-409-6700, F:

CONSIGNEE
DHSEM
47 BATAAN BLVD

SANTA FE. NM 87508
F:

3RD PARTY BILL T0:

Priority 1 Inc.
P.O. Box 398
North Little Rock,
Accounts Payable,

AR 72115

501-371-9814, F: 501-374-5960

Special Instructions 

Accesso ale(X)

1500 MEDICAL

1500 GRAND TOTALS:

PICK UP THURSDAY 04/23 DELIVER DIRECT

BOL N0: 50122725907

Carrier: ROLLER EXPRESS INC

Pickup Date: 04-23-2020
Origin Terminal

P: F:
Destination Terminal

P: F:

70 . 0
SCAG: 106396
Total Qty: 4 .0

Freight Terms:
Prepaid: 
Collect: 
3rd Party: 

Description

 

 

Where the rate is dependent 0n value. shippers are required to state speci?cally' in writing the agreed or declared value of the property as follows: 'The agreed or declared value of the

 

 

 

 

 

property is speci?cally stated by the shipper to be not exceeding per

Remit COD to:

Collect Prepaid Customer check acceptable COD Amount: 

Note: Liability limitation for loss or damage in this shipment may be applicable. See 49 USC 14706(c)(1)(A) and (B).

Received. subject to individually determined rates or contracts that have Trailer Freight The Carrier shall not make delivery of this

been agreed upon in writing between the carrier and shipper, if applicable. Loaded' Counted' shipment without payment of and all other lawful
otherwise to the rates. classi?cations and rules that have been established charges.

by the carrier and are available to the shipper. on request. and to all by Shipper by Shipper

applicable state and federal regulations. by Driver by Driver Shipper:

 

 

 

Shipper Signature/Date

Carrier SignaturelPicl-rup Date

 

 

This is to certify that the above named materials are properly classi?ed. packaged. marked and
labeled and are in proper condition for transportation according to the applicable regulations Shipper?DOL 

 

Carrier acknowledges receipt of packages and required placards. Carrier
certi?es emergency response information was made available andlor carrier has
the DOT emergency response guidebook or equivalent documentation in
vehicle. Property described above is received in good order. except as noted.

Carrier: 4.72,: g: 4/ijb

 

all Pericl?



 

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