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NATIONAL VEHICLE SERVICE CONTRACT APPLICATION, TERMS & CONDITIONS (All Vehicles up to and including Transit and F 550 series) REGISTRATION INFORMATION Vehicle Identification Number 111FITI71wI21BI6151FIEIDI 1 1 B 1 31 81 0 Internet Sale I Current Mileage D Yes ~ No 6.400 1 RECEIVED JAN 2 9 2016 KITTITAS COUNTY SHERIFF ACCOUNTING Signature Date Warranty Start Date 12129/2015 05/26/2015 Current Hours* IPP Term D I ~ I FORD PROTECT DCPO D Incomplete (Cab/chassis) I D Limo/Livery Wrap Surcharges: D 12 Months/12,000 Miles D TurbochargerlSupercharger D Snowplow ~ Commercial Use D Specialty -Emergency (Fire, Ambulance, Police pursuit units -except Ford police Interceptor), Limo, Livery, Shuttle, Tow Truck} D com~onent Wrap ( on-CPO) New Plan Coverage: Core -PowertratnCARE, BaseCARE, ExtraCARE, PremiumCARE (Standard Deductible IS $1 OO) LeaseCARE -New PremiumCARE with Wear Items on Ford and Lincoln vehicles -(Standard Deductible is SO) Rental Care -(RentaICARE-Standard Deductible is SO) Super Duty Coverages -(Diesel EngineCARE, Diesel EngineCARE Plus -Standard Deductible is $1 OO) Used Plan Coverage: Core (PowertrainCARE, BaseCARE, ExtraCARE, PremiumCARE -Standard Deductible is $1 OO) PLAN COVERAGE ~ New Plan D Used Plan Plan Name A Deductible Plan Term Plan Expiration -(Earliest of all 3) Purchase Months Mileage Hours* Date Mileage Hours* Price PremiumCARE $100 60 1125,000 I 05/26/2020 1125,000 I $ 3,540.00 Sales Tax Total Purchase Price with SalesTax $ 304.44 $ 3,844.44 Options D First Day Rental Delete D Enhanced Rental D Interior/Exterior Lighting Delete Plan Name B Deductible Plan Term Plan Expiration -(Earliest of all 3) Purchase Sales Tax Total Purchase Price Months Mileage Hours* Date Mileage Hours* Price with SalesTax I 1 1 1 $ $ $ Options D First Day Rental Delete D Enhanced Rental D Interior/Exterior Lighting Delete *Super Duty Coverages and Incomplete Vehicle Plan Coverages require Current Hours and I Expiration Hours for all vehicles with an hour meter. Total $ 3,540.00 $ 304.44 $ 3,844.44 DISCLOSURE INFORMATION THE PURCHASE OFTHIS AGREEMENTIS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN FINANCING FOR A MOTOR VEHICLE. YOU MAY PURCHASETHE SERVICE CONTRACT BY CASH OR UNSECURED CREDIT CARD. IF YOU ELECT TO PURCHASE THIS AGREEMENT, IT GIVES YOU SPECIFIC LEGAL RIGHTS, WHICH MAY VARY FROM STATE TO STATE. I acknowledge receipt of a complete copy of this Application and the Terms and Conditions (the "Entire Agreement") at the time of signing and agree to all the terms and conditions. I agree to maintain the covered vehicle in accordance with the manufacturer's stated periodic maintenance recommendations as a condition of receiving coveraqe under this Aqreement except as otherwise provided bv law. Mississippi Residents Only: By signing below, I agree to Washington Residents Only: By initialing this box, I acknowledge I have reviewed with Dealer the the binding arbitration language in the Mississippi Section . I ~ section of this Service Contract titled, What This Agreement Covers and What is Not Covered, Your a.f~ Responsibilities for Care of the Vehicle, Implied Warranty of Merchantitibility and Your and Our Rights __ to Cancel Agreement. Signature (not valid without Signature) SERVICE CONTRACT HOLDER I PURCHASER Signature (N~~a~c;without S~nature) _ 1~-a./lS76~~ Name KITTITAS COUNTY !I'1EPlll'n SFFlCE City ELLENSBURG DEALERSHIP JNFORMATION -Dealer Name Corwin Ford Tri-Cities Address 1 1225 North Autoplex Way City Pasco Zip Code 99301 Employee Stars Id I State WA I Zip Code 98926 Address 2 State WA Telephone No ESP 8240-Nat App/Provs (Oct 15) (Previous Editions May Not be Used) Signature Date 12/29/2015 Address 307 UMPTANUM RD E-mail Address Service Contract Lienholder Name FOR OFFICE USE ONLY