Date: 5/23/2022 Bill of Lading — Short Form — Not Negotiable Bill of Lading Number:

ORDER ID #: 0740988 0740988

CA RRIER SCA C:

CA RRIER NA ME: Pro Number:

WA RNING MUST ENTER TRA ILER NUMBER BA R CODE SPA CE
TRA ILER NUMBER:
Serial number(s):

Third Party Freight Charges Bill to Freight Charge Terms: Third Party

3rd Party Bill To: 3RD Party:

A scena Retail Group C / O KINGSGA TE LOGISTICS, LLC
9100 WEST CHESTER CENTER, SUITE 300 See '3rd Party Bill To Information' to the Left
WEST CHESTER OH 45069

SHIP FROM

BLENDED Purchase Order Number(s):

12828 CARMENITA ROAD 764570, 764572, 764576, 764578
SANTA FE SPRINGS , CA 90670
5628225285
Ready Date: 05/27/2022 10:00
Shipper's Reference:

SHIP T O

DELIVERY # 1 Delivery # 1 Purchase Order Number(s):

764570, 764572, 764576, 764578
MAURICES
200 HERITAGE DR
200 HERITAGE DR
PATASKALA , OH 43062
513-874-7447
Required Delivery Date: 05/30/2022 08:00

Special Instructions: closed for lunch 12:00-12:45 pm thanks

SHIPMENT INFORMATION

Handling Unit Package LTL Only DLVR

#

Qty Type Skids Size (LxWxH) Weight HM (X) Commodity Description NMFC No. Class DLVR #

3
63 CRTN 48 X 40 X 80 2909 LBS No Clothing Merchandise 100 1
Stackable?: N

1
14 CRTN 48 X 40 X 70 268 LBS No Clothing Merchandise 100 1
Stackable?: N

2
59 CRTN 48 X 40 X 80 2073 LBS No Clothing Merchandise 100 1
Stackable?: N

TOTALS
136 6 5250 LBS

Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property as COD A mount: $
follows: “The agreed or declared value of the property is specifically stated by the shipper to be not exceeding _______________ per _______________________________________________
_______________.
Fee terms:
Collect ▢ Prepaid ▢ Customer check acceptable ▢

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

The carrier shall not make delivery of this shipment without payment of
Received, subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper, charges and all other lawful fees.
if applicable, otherwise to the rates, classifications, and rules that have been established by the carrier and are available to the
shipper, on request, and to all applicable state and federal regulations. Shipper Signature
__________________________________________________________

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Shipper Signature/Date T railer Freight Carrier Signature/Pickup Date
Loaded: Counted:
___________________________________________ __________________________________________
This is to certify that the above named materials are properly classified, packaged, marked, and labeled, and are in ▢ By ▢ By shipper Carrier acknowledges receipt of packages and required placards. Carrier
proper condition for transportation according to the applicable regulations of the DOT. shipper certifies emergency response information was made available and/or
carrier has the DOT emergency response guidebook or equivalent
▢ By documentation in the vehicle. Property described above is received in good
▢ By driver/pallets order, except as noted.
driver said to
contain

▢ By
driver/pieces

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