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MAINTENANCE PLAN APPLICATION, <br />TERMS & CONDITIONS <br />RECEIVED '~ I FORD PROTECT <br />NEW AND USED VEHICLES <br />REGISTRATION INFORMATION KITTITAS COUNTY SHERIFF <br />1"1"('\IIMTII.l n <br />VehiCle IdentlReatlon Num.ber (I'VIN"I (17 Digits) Signature Date I Warranty Start Dat.e IZI Gas/Hybrid <br />1 1 1 FIT I 71wI2 1 B I 6 1 8 1 G I E I C I 2 1 5 1 1 1 1 1 3 1 05/04/2016 03125/2016 D Diesel <br />Internet Sale Current Mileage <br />D Electric <br />D Yes IZI No 56 <br />Surcharges D 12 Monthl12,OOO Miles (PMP Only· Not applicable for CPO) <br />DCPO <br />o Snow Plow (PMP Only· Not applicable for PMP E, PMP L, PMP BL or CPO) D Incomplete <br />IZI r<pecial% -Emergency (fire, ambulance, all police), limo, livery, shuttle, tow trucks -D Medium Duty <br />Gas/Hy rid , Diesel and Lincoln Premium Majnte .nan ~e Plans Only) <br />-PREMIUM MAINTENANCE PLANS : Gas/Hybrid, ElectTl c, Diesel, Lincoln. Black La b.el, Incom p,lete (Ca b/Chassis), Medium Duty, CPO - <br />(Standard $0 Deductible) <br />LIMITED, BASIC AND ENGINE MAINTENANCE PLANS: Gas/Hybrid and Diesel-(Standard $0 Deductible) <br />For Premium Maintenance Plans (PMP) coverage BEGINS at the New Vehicle Limited Warranty Start Date and Zero Miles. Coverage <br />ENDS at THE EARLIER OF the Number of Years Purchased, the Number of Miles Purchased or upon completion of the Maximum Number <br />of Service Intervals Purchased from the New Vehicle Limited Warranty Start Date or Zero Miles. <br />For LIMITED, BASIC AND ENGINE Maintenance Plans coverage BEGINS at the Signature Date and Current Mileage. Coverage ENDS at <br />THE EARLIER OF the Number of Years Purchased, the Number of Miles Purchased or upon completion of the Maximum Number of Service <br />Intervals Purchased from the Signature Date or Current Mileage. <br />PLAN COVERAGE <br />Plan Name Plan Term Plan Expiration (Earlier of) Purchase Price Sales Tax Totlll Purchase <br />Months Mileage Date Mileage Price with Sales Tax <br />Premium Maintenance 60 \125000 03/25/2021 1125000 $ 3,135.00 $ 269.61 $ 3,404.61 <br />Premium Mai~tenance I D First Day Rental (Not available on Incomplete or <br />Plan Options Medium Duty Plans) <br />Mainten~nce I D Full Synthetic Oil (Not available on Lincoln, Black Label, Electric, <br />Plan Options CP Incomplete Plans and Medium Duty) <br />Service Intervals Service visits <br />D 3,000" IZI 5,000 D 7,500 D 10,000+ 25 <br />"Not available on PMP Plans. +only service interval available for PMP Electric <br />DISCLOSURE INFORMATION <br />NOTE: THE PURCHASE OF THIS MAINTENANCE PLAN IS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN FINANCING FOR A <br />MOTOR VEHICLE. <br />I acknowledge receipt of a complete copy of this Maintenance Plan (the App lication, Terms and Conditio ns co nstitute the "Entire Maintenance <br />Plan") at the time of signing and agree to all the terms and Co nditio ns. I agree to maintain me CQvered vehicle in accordance with the <br />manufacturer's stated periodic maintenance recommendations as a condition of receiving coverage under this Maintenance Plan except as <br />otherwise provided by law. <br />MAINTENANCE PLAN/PURCHASER <br />Signature (Not Valid without Signature) Signature Date <br />Original Signed by: KllllTAS SHERIFF'S OFFICE \' Q <br />It / 111 tiP f~'-/.>. (...~ , 05/04/2016 ~~~ .-'~ <br />Name Address <br />KITTITAS COUNTY SHERIFF'S OFFICE 307 UMPTANUM RD <br />City I 'State Zip Code I E·mall Address Maintenance Plan Lienholder Name <br />ELLENSBURG WA 98926 <br />DEALERSHIP INFORMATIQ,N <br />OeaJe.rshl~ II:I~ Original SlgntUj ,;(97r <br />Dealer ~~ ....... /-- <br />Corwin Ford Tri-Cities <br />Address 1 Address 2 <br />1225 North Autoplex Way <br />Llty State <br />Pasco WA <br />Zip Code Telephone No FOR OFFICE USE ONLY <br />99301 <br />Employee Stars Id P&ACode <br />I [ [ I I [ [ [ I [ [ o [ 6 I 4 I 6 I 7 I <br />ESP 8324 -MNTC (Oct 15) (Previous Editions May Not be Used)