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CLAIM FOR LOSS OR DAMAGE FORM CLAIMANT: __________________________________ HORIZON LINES BILL OF LADING: ________________________ ADDRESS: __________________________________ VESSEL: ________________________ CITY, STATE __________________________________ CONTAINER NUMBER: ________________________ ZIP CODE: _______________________ TELEPHONE: _______________________ ORIGIN PORT: ________________________ EMAIL ADDRESS: ___________________________________ DESTINATION PORT: ________________________ CLAIMANT’S REF NUMBER: ___________________ DATE OF ARRIVAL: ________________________ NAME & ADDRESS OF CONSIGNOR OR SHIPPER: _________________________________________________________________

_________________________________________________________________ NAME & ADDRESS OF CONSIGNEE: _________________________________________________________________ _________________________________________________________________ DESCRIPTION OF SHIPMENT: _________________________________________________________________ _________________________________________________________________ NATURE OF LOSS SHORTAGE ( ) DAMAGE ( ) WATER DAMAGE ( ) A CLAIM IS MADE AGAINST HORIZON LINES IN CONNECTION WITH ABOVE DESCRIBED SHIPMENT FOR DETAILED ITEMIZATION SHOWING HOW AMOUNT OF CLAIM IS DETERMINED (NUMBER & DESCRIPTION OF ARTICLE AND EXTENT OF LOSS OR DAMAGE, INVOICE PRICE OF ARTICLE, AMOUNT OF CLAIM) THE FOLLOWING DOCUMENTS ARE SUBMITTED IN SUPPORT OF THIS CLAIM ( ) BILL OF LADING ( ) PACKING LIST ( ) DELIVERY RECEIPT ( ) OTHER DOCUMENTS ( ) FREIGHT BILL ( ) CONSUMPTION ENTRY (USA) ( ) INSPECTION REPORT ( ) SALVAGE RETURN ( ) SHIPPERS INVOICE ( ) TRAILER INTERCHANGE ( ) SURVEY REPORT ( ) AUTO REPAIR ESTIMATES REMARKS: _______________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ NOTICE OF LOSS/DAMAGE WAS GIVEN TO CARRIER ON: ________________________ TO ______________________________ DATE NAME AT: ______________________________________________ BY: _____________________________ HORIZON LINES LOCATION CLAIMANT REPRESENTATIVE

I certify statement as correct: SIGNED ___________________________ DATE ___________________________

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CLAIM FOR LOSS OR DAMAGE FORM 1. Where to File Claim HORIZON LINES, LLC ATTN: CARGO CLAIMS DEPARTMENT 2550 WEST TYVOLA ROAD, SUITE 530, COLISEUM 3 CHARLOTTE, NC 28217 Email: HLclaims@horizonlines.com Fax: (704) 973-7140 2. Notice of Loss or Damage a.) In order that the Carrier might have an opportunity to inspect the goods and thereby properly verify claims, any damage discovered should be reported to the carrier immediately upon discovery and during the transfer or custody.

b.) The actual auto inspection process should take 15 minutes and suggest allowing one hour for coordination, documentation and preparation. c.) When shipping your auto, please present photo ID, title and registration (original copy) of your vehicle. If you are not in possession of your title, you may present the original registration containing the lien holder’s information.

i) Non – Owner of Vehicle: if the person shipping and or receiving the vehicle is other than the Owner, a notarized letter of authorization from the Owner(s) is needed. If the vehicle is co-owned, both registered Owners must sign the consent form. The consent form and notarization must be submitted to the customer service representative.

3. Time Limits are per terms and conditions posted on the web page. 4. Minimum Requirements to Constitute a Claim All claims must be in writing. A written notice containing sufficient information to identify the shipment, stating a specific or determinable amount claimed and holding the carrier liable for that amount will constitute a claim. 5. Documents to be Submitted In addition to the documents mentioned on the front of this form, claimants should submit all other documents or other information that will assist the carrier in evaluating the claim, and in determining the proper measure of damages. Claimants are encouraged to submit claims promptly and not to delay filing claims if all information is not readily at hand. All damages claimed must be supported before any claim can be paid. 6. The Bill of Lading The bill of lading and the tariffs under which the carrier accepted the goods for carriage will govern the determination of the claim. The terms and conditions of the bill of lading and the tariffs cannot be waived except in writing and not waived or modified by any statement found on this form. 7. Provisions of Law Carriers are bound by law to pay only those claims for which an investigation establishes that the carrier is legally liable. Failure to abide by these laws in the processing of claims can subject the carrier as well as the claimant to fines and penalties. 8. Reminders to Claimant a.) Shortage Claims Claims for shortages on container load deliveries must be supported by seal records form the time the consignee or his designated agent took delivery of the container up to the time the trailer is unloaded; and by an unloading report that shows the time and date of unloading, number of pieces outturned and all discrepancies discovered at the time of unloading. The unloading report should also record the seal removed at the time of unloading and be signed by the unloading supervisor.

b.) Damage Claims If the carrier was notified of the damage, please identify the particulars of this notice. Attach to your claims any inspection report made by the carrier or surveyor, photographs, documents or information that will help the carrier determine the cause or extent of the damage. Advise the carrier of the final disposition of the goods, and of any salvage returns.

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9. Horizon Lines limits respective Liability as follows and may consider accepting a Hold Harmless from Shipper if shipment is required:

a.) After market items b.) Damage to under carriage including lower limits of bumpers and rocker panels. c.) Interior d.) Windshield cracks e.) In excess of 260” long, 96” high, 84” wide f.) Autos delivered without an inspection/documentation of inspection will not be considered for a claim. g.) Gas in excess of ¼ of a tank will not be received.

Version 1; Nov, 2014 jae