19-R-0323_H14.pdf

TRANSPORT EQUIPMENT DELAY CERTIFICATE

1. CONSIGNOR 2. CONSIGNEE 3. PRODUCT

4. CARRIER 5. TRAILER NUMBER 6. DATE SHIPPED

7. FREIGHT BILL NUMBER 8. CBL NUMBER 9. SEAL NUMBER

10. LOADING/UNLOADING INFORMATION

DATE RECEIVED TIME DATE RECEIVED TIME

A. ARRIVED D. FINISH

B. ACCEPTED FOR

LOADING/UNLOADING E. UNIT RELEASED

C. START F. TOTAL HOUR HELD

11. REASON FOR DELAY (Make a complete statement adequately describing each segment of delay, amount of time on each delay, and whether delay was the responsibility of carrier or consignee/consignor)

12. DETENTION CERTIFICATION STATEMENT : I certify that the above information is true and correct to the best of my knowledge.

SIGNATURE AND TITLE OF CONSIGNEE SIGNATURE AND TITLE OF SHIPPER SIGNATURE OF DRIVER

13. NOTE TO CARRIER: A copy of "TRANSPORT EQUIPMENT DELAY CERTIFICATE" must accompany each detention invoice to provide documentation for invoice certification and payment.

FORM H-14

Sheet1