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MAINTENANCE PLAN APPLICATION, TERMS & CONDITIONS NEW AND USED VEHICLES REGISTRATION INFORMATION RECEIVED KITTITAS COUNTY SHERIFF ACCOUNTING L I N C O L N PROTECT r, �;_e (-) a cy Vehicle Identification Number "VIN" 17 Digits) Signature Date Warranty Start Date ❑X Gas/Hybrid Sales Tax Total Purchase KITTITAS COUNTY 307 W UMPTANUM RD Months Mileage Date Mileage Price E-mail Address Price with Sales Tax Premium Maintenance WA 60 125000 05/V 2022 125000 1 F T F W 1 1 1 E I F 1 5 H K I D 1 2 1 0 1 7 1 3 4 07/20/2017 05/11/2017 4 Plan Options Electric, CPO, BMP and EMP) ❑ Plck Up and Delivery Option (Lincoln only -excluding Fleet vehicles) Service Intervals ❑ 3,000" ❑X 5,000 ❑ 7,500 ❑ 10,000+ Service visits Internet Sale IPP Term Current Mileage E] Diesel ❑ Yes X❑ No ❑ 218 ❑ Electric Surcharges ❑ 12 Month/12,000 Miles (PMP Only - Not applicable for CPO) ❑ CPO ❑ 36 months136,000 miles (Ford and Competitive Make or 48 month/50,000 miles (Lincoln vehicles) (PMP Only - Not applicable for CPO) ❑ E] incomplete Snow Plow (PMP Only - Not applicable for PMP E, PMP L, PMP BL or PMP CPO) Specialty - Emergency (lire, ambulance, all police pursuit units (except Ford Police Interceptor)), limo, livery, shuttle, tow ❑ Medium Duty trucks - (Gas/Hybrid, Diesel and Lincoln Premium Maintenance Plans Only) PREMIUM MAINTENANCE PLANS : Gas/Hybrid, Electric, Diesel, Lincoln, Black Label, Incomplete (Cab/Chassis), Medium Duty, CPO - (Standard $0 Deductible LIMITED, BASIC AND ENGIN MAINTENANCE PLANS • Gas/Hybrid and Diesel- (Standard $0 Deductible For Premium Maintenance Plans (PMP) coverage BEGINS at the New Vehicle Limited Warranty Start ate and Zero Miles. Coverage ENDS at THE EARLIER F the Number of Years Purchased, the Number of Miles Purchased or upon completion of the Maximum Number of Service Intervals Purchased from the New Vehicle Limited Warranty Start Date or Zero Miles. For LIMITED BASIC AND ENGINE Maintenance Plans coverage BEGINS at the Signature Date and Current Mileage. Coverage ENbS at THE EARLIER OF the Number of Years Purchased, the Number of Mies Purchased or upon completion of the Maximum Number of Service Intervals Purchased from the Signature Date or Current Mileage. PLAN COVERAGE Plan Name Signature Date Plan Term Plan Expiration (Earlier of) Purchase Sales Tax Total Purchase KITTITAS COUNTY 307 W UMPTANUM RD Months Mileage Date Mileage Price E-mail Address Price with Sales Tax Premium Maintenance WA 60 125000 05/V 2022 125000 $ 3135.00 $ 263.34 $ 3398.34 WA Zip Code 0 98632 FOR OFFICE USE ONLY Premium Maintenance ❑ First Day Rental (Not applicable on Black Label 2016 Model Maintenance ❑ Full Synthetic Oil (Not applicable on fully Plan Options Years and Prior, Incomplete or Medium Duty Plans) 4 Plan Options Electric, CPO, BMP and EMP) ❑ Plck Up and Delivery Option (Lincoln only -excluding Fleet vehicles) Service Intervals ❑ 3,000" ❑X 5,000 ❑ 7,500 ❑ 10,000+ Service visits "Not available on PMP Plans. +only service interval available for PMP Electric 25 DISCLOSURE INFORMATION NOTE: THE PURCHASE OF THIS MAINTENANCE PLAN IS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN FINANCING FOR A MOTOR VEHICLE. 1 acknowledge receipt of a complete copy of this Maintenance Plan (the Application, Terms and Conditions constitute the "Entire Maintenanc$ Plan') 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 stared periodic maintenance recommendations as a condition o receiving coverage under this Maintenance Plan except as otherwise provided by law. MAINTENANCE PLANWR HASER Signature (Not Valid without gnatu Signature Date (}7120/2017 a 116_ i 7 Name Address Dealer Name KITTITAS COUNTY 307 W UMPTANUM RD Columbia Ford, Inc. City State Zip Code E-mail Address Maintenance Plan Lienholder Name ELLENSBURG WA 98926 NONE DEALERSHIP INFORMATION Dealership Signature BETH SHEETS Dealer Name Columbia Ford, Inc. Address 1 Address 2 700 -7th Avenue City State Longview WA Zip Code Telephone No 98632 FOR OFFICE USE ONLY Employee Stars Id P&A Code 0 1 s 1 6 0 2 0 1 0 1 2 4 -7—L7 5 1 4 ESP 8324 - MNTC (Oct 16) (Previous Editions May Not be Used)