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MAINTENANCE PLAN APPLICATION, <br />TERMS & CONDITIONS <br />NEW AND USED VEHICLES <br />REGISTRATION INFORMATION <br />RECEIVED <br />KITTITAS COUNTY SHERIFF 11 d <br />\_'/ I T LI NCO LN <br />PROTECT <br />Vehicle Identification Number "VIN" <br />17 Digits) <br />SIqfifiwALbWtWflC, <br />07/13/2017 <br />Warranty Start Date <br />05/30/2017 <br />� Gas/Hybrid <br />1 <br />F <br />M <br />5 <br />K <br />S <br />A <br />R <br />5 <br />H <br />G C <br />8 7 <br />3 <br />3 <br />1' <br />$ 2680.00 <br />$ 225.12 <br />$ 2905.12 <br />Premium Maintenance <br />❑ First Day Rental (Not applicable on Black Label 2016 Model <br />Maintenance <br />❑ Full Synthetic Oil (Not applicable on fully <br />Plan Options <br />Years and Prior, Incomplete or Medium Duty Plans) <br />Zip Code <br />Plan Options <br />Electric, CPO, BMP <br />and EMP) <br />❑ Pick Up and Delivery Option (Lincoln only -excluding Fleet <br />FOR OFFICE USE ONLY <br />Employee Stars Id <br />Internet Sale <br />❑ Yes X❑ No <br />IPP Term <br />❑ J <br />Current Mileage <br />5 <br />❑ Diesel <br />❑ Electric <br />Surcharges ❑ 12 Month/12,000 Miles (PMP Only - Not applicable for CPO) <br />❑ 36 months/36,000 miles (Ford and Competitive Make or 48 month/50,000 miles (Lincoln vehicles) (PMP Only - Not <br />applicable for CPO) <br />❑ Snow Plow (PMP Only - Not applicable for PMP E, PMP L, PMP Bi- or PMP CPO) <br />❑ CPO <br />Incomplete <br />Q Specialty - Emergency (fire, ambulance, all police pursuit units (except Ford Police Interceptor)), limo, livery, shuttle, tow <br />trucks - (Gas/Hybrid, Diesel and Lincoln Premium Maintenance Plans Only) <br />Medium Duty <br />PREMIUM MAINTENANCE PLANS : Gas/Hybrid, Electric, Diesel, Lincoln, Black Label, Incomplete (Cab/Chassis), Medium Duty, <br />CPO - (Standard $0 Deductible <br />LIMITED, BASIC AND ENGIN MAINTENANCE PLANS : Gas/Hybrid and Diesel- (Standard $0 Deductible) <br />For Premium Maintenance Plans (PMP) coverage BEGINS at the New Vehicle Limited Warranty Start bate and Zero Miles, <br />Coverage ENDS at THE EARLIER F the Number of Years Purchased, the Number of Miles Purchased or upon completion of <br />the Maximum Number of Service Intervals Purchased from the New Vehicle Limited Warranty Start Date or Zero Miles. <br />For LIMITED, BASIC AND ENGINE Maintenance Plans coverage BEGINS at the Signature Date and Current Mileage. <br />Coverage ENDS at THE EARLIER OF the Number of Years Purchased, the Number of Miles Purchased or upon completion of <br />the Maximum Number of Service Intervals Purchased from the Signature Date or Current Mileage. <br />PLAN COVERAGE <br />Plan Name <br />Plan Term <br />Pian Expiration (Earlier of) <br />Purchase <br />Sales Tax <br />Total Purchase <br />KITTITAS COUNTY <br />307 W UMPTANIUM RD <br />Months Mileage <br />Date <br />Mileage <br />Price <br />Maintenance Plan Lienholder Name <br />price with Sales Tax <br />Premium Maintenance <br />98926 <br />72 <br />100000 <br />05/30/2023 <br />100000 <br />$ 2680.00 <br />$ 225.12 <br />$ 2905.12 <br />Premium Maintenance <br />❑ First Day Rental (Not applicable on Black Label 2016 Model <br />Maintenance <br />❑ Full Synthetic Oil (Not applicable on fully <br />Plan Options <br />Years and Prior, Incomplete or Medium Duty Plans) <br />Zip Code <br />Plan Options <br />Electric, CPO, BMP <br />and EMP) <br />❑ Pick Up and Delivery Option (Lincoln only -excluding Fleet <br />FOR OFFICE USE ONLY <br />Employee Stars Id <br />P&A Code <br />o <br />- de_-_- <br />o 1 8 1 6 1:=0 <br />vehicles) <br />1 0 <br />2 <br />1 a <br />7 <br />Service Intervals <br />❑ 3,000'" ® 5,000 ❑ 7,500 ❑ 10,000+ <br />Service visits <br />a <br />*Not available on PMP Plans, <br />+ only service interval available for PMP Electric <br />20 <br />DISCLOSURE INFORMATION <br />NOTE: THE PURCHASE OF THIS MAINTENANCE PLAN IS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN <br />FINANCING FOR A MOTOR VEHICLE. <br />/ acknowledge p <br />receipt of a complete copy of this Maintenance Plan (the A plication, Terms and Conditions constitute he "Entire <br />Maintenance Plan) at the time of signing and agree to all the terms an conditions. 1 agree to maintain thecovered vehicle in <br />accordance with the manufacturer's stated periodic maintenance recommendations as a condition of receiving coverage under <br />this Maintenance Plan except as otherwise provided by law. <br />MAINTFNANCF PLAN/PURCHASER <br />Signature (Not Valid without Signature) <br />Signature Date <br />-QW-4=3/204 7 <br />Name <br />Address <br />KITTITAS COUNTY <br />307 W UMPTANIUM RD <br />City <br />State <br />Zip Code <br />E-mail Address <br />7 <br />Maintenance Plan Lienholder Name <br />ELLENSBURG <br />WA <br />98926 <br />700 -7th Avenue <br />NONE <br />nFAI FRSHIP INFORMATION <br />Dealership Signature <br />~- <br />Dealer Name <br />Columbia Ford, Inc. <br />Address 1 <br />Address 2 T <br />700 -7th Avenue <br />City <br />State <br />Longview <br />WA <br />Zip Code <br />Telephone No <br />98632 <br />FOR OFFICE USE ONLY <br />Employee Stars Id <br />P&A Code <br />o <br />- de_-_- <br />o 1 8 1 6 1:=0 <br />0 <br />1 0 <br />2 <br />1 a <br />7 <br />7 <br />5 <br />1 <br />a <br />ESP 8324 - MNTC (Oct 16) (Previous Editions May Not be Used) <br />L_ _J <br />