Mailing Service Samples.pdf

Port of Hood River

Mailing Service RFP - Samples

1. Envelope #10 (blue ink with logo)

2. Envelope #9 (pre-addressed return envelope)

3. First Invoice – Tolls

4. Late Invoice – Tolls

5. BreezeBy Statement – 1 page

6. BreezeBy Statement – Multiple pages

11/20/2024

UNPAID TOLL INVOICE- Affidavit of Non-Liability or Dispute Request

Regarding the use of the toll facility listed on the Unpaid Toll Invoice for Toll Transaction(s) on the reverse side, the registered owner of the vehicle, identified by the license plate specified, has the opportunity to contest liability.

1. Complete Section A or B.

# If completing Section A (Affidavit of Non-Liability), do not include payment.

# If completing Section B (Dispute), include Check or Money Order for the Toll(s) Due.

2. Sign and date Certification.

Section A: Affidavit of Non-Liability

Our records indicate that a vehicle registered to you did not pay the toll at the location(s) and date/time(s) described on the attached Invoice for Unpaid Tolls. Pursuant to Oregon State Law ORS 381.312, The Port of Hood River (Port) may collect unpaid tolls, administrative fees, and civil penalties from registered vehicle owners for use of the toll bridge. If you did not own this vehicle on the transaction date, complete the declaration below and return it within twenty-one (21) days from the date of this notice to avoid additional fees and penalties or escalation to Collections.

By signing below, I declare that the vehicle bearing the license plate number listed on the Invoice was not owned by me on the violation date for the following reason (Please check only one reason below):

Sold Rented Leased Stolen

The name and address of the responsible party is:

Name _________________________________________ Driver License Number _____________________ DL State _____________________

Address _________________________________________ City_____________________ State__________ ZIP Code__________________

Date of theft, sale, or execution of lease/rental agreement_______________________

Note: Proof of a bona fide sale or transfer of the vehicle, or a proof of written rental/lease agreement with a bona fide renting or leasing company, or a copy of a theft police report or insurance claim must be provided. Failure to provide or accurately complete the above information, as well as lack of verification of such by DMV, will result in this declaration being disregarded.

Section B. Dispute

CERTIFICATION OF INADVERTENT TOLL TRANSACTION IN A BREEZEBY LANE.

I hereby declare that this invoice was issued to me in error, that I paid the toll in full at the time of crossing.

I hereby declare that I took every reasonable action to pay the bridge toll at a toll booth if open, or if a toll booth was not open I had to use pass through the toll plaza without paying for the following reason(s) beyond my control (Describe reason(s) in detail):

To be considered for SECTION B Dispute, you must send a Check or Money Order (No Cash) for the Total Due.

Sign and Certify

I declare under the penalty of perjury that the foregoing is true and correct.

Print Name ____________________________________________ Signature ____________________ Date _________________________

Contact Phone ____________________________ Contact Email ____________________________________________________________

V0001

12/20/2024

LATE NOTICE UNPAID TOLL INVOICE - Affidavit of Non-Liability or Dispute Request

Regarding the use of the toll facility listed on the Final Invoice for Toll Transaction(s) on the reverse side, the registered owner of the vehicle, identified by the license plate specified, has the opportunity to contest liability.

1. Complete Section A or B.

# If completing Section A (Affidavit of Non-Liability), do not include payment.

# If completing Section B (Dispute), include Check or Money Order for the Toll(s) Due.

2. Sign and date Certification.

Section A: Affidavit of Non-Liability

Our records indicate that a vehicle registered to you did not pay the toll at the location(s) and date/time(s) described on the attached Invoice for Unpaid Tolls. Pursuant to Oregon State Law ORS 381.312, The Port of Hood River (Port) may collect unpaid tolls, administrative fees, and civil penalties from registered vehicle owners for use of the toll bridge. If you did not own this vehicle on the transaction date, complete the declaration below and return it within fifteen (15) days from the date of this notice to avoid additional fees and penalties or escalation to Collections. The undersigned declares that the vehicle bearing the license plate number above was not owned by me on the violation date for the following reason (Please check only one reason below):

By signing below, I declare that the vehicle bearing the license plate number listed on the Invoice was not owned by me on the violation date for the following reason (Please check only one reason below):

Sold Rented Leased Stolen

The name and address of the responsible party is:

Name _________________________________________ Driver License Number _____________________ DL State _____________________

Address _________________________________________ City_____________________State__________ZIP Code__________________

Date of theft, sale, or execution of lease/rental agreement_______________________

Note: Proof of a bona fide sale or transfer of the vehicle, or a proof of written rental/lease agreement with a bona fide renting or leasing company, or a copy of a theft police report or insurance claim must be provided. Failure to provide or accurately complete the above information, as well as lack of verification of such by DMV, will result in this declaration being disregarded.

Section B. Dispute

CERTIFICATION OF INADVERTENT TOLL TRANSACTION IN A BREEZEBY LANE.

I hereby declare that this invoice was issued to me in error, that I paid the toll in full at the time of crossing.

I hereby declare that I took every reasonable action to pay the bridge toll at a toll booth if open, or if a toll booth was not open I had to use pass through the toll plaza without paying for the following reason(s) beyond my control (Describe reason(s) in detail):

To be considered for SECTION B Dispute, you must send a Check or Money Order (No Cash) for the Total Due.

Sign and Certify

I declare under the penalty of perjury that the foregoing is true and correct.

Print Name ____________________________________________ Signature ____________________ Date _________________________

Contact Phone ____________________________ Contact Email____________________________________________________________

V0002

BREEZEBY-INVOICE

1000 E.Port Marina Drive, Hood River, OR 97031

Transaction Date Post Date Transaction Type Debits Payments/Credits

Total Debits/Credits $0.00 $97.25

Total Payments/Adjustments ($97.25)

Amount Due by 01/16/2025 : $509.00

541-386-1645, https://csc.portofhoodriver.com Page 4 of 4