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MAINTENANCE PLAN APPLICATION, <br />TERMS & CONDITIONS <br />RECEIVED <br />JAN 2 9 20!S ~ I FORD PROTECT <br />NEW AND USED VEHICLES <br />REGISTRATION INFORMATION <br />KITTITAS COUNTY SHERIFF <br />ACCOUNTING <br />Vehicle Identification Number ("VIN") (17 Digits) Signature Date I Warranty Start Date <br />I liFITI71wI21BI6191FIEIDI1181318121 12/29/2015 OS/27/2015 <br />Internet Sale Current Mileage <br />D Yes ~ No 7443 <br />Surcharges D 12 Month/12,OOO Miles (PMP Only -Not applicable for CPO) <br />D Snow Plow (PMP Only -Not applicable for PMP E, PMP L, PMP BL or CPO) <br />~ special%, -Emergency (fire, ambulance, all police), limo, livery, shuttle, tow trucks - <br />(Gas/Hy rid, Diesel and Lincoln Premium Maintenance Plans Only] <br />~ Gas/Hybrid <br />D Diesel <br />D Electric <br />DCPO <br />D Incomplete <br />D Medium Duty <br />PREMIUM MAINTENANCE PLANS : Gas/Hybrid, Electric, Diesel, Lincoln, Black Label, Incomplete (Cab/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 Total Purchase <br />Months Mileage Date Mileage Price with Sales Tax <br />Premium Maintenance 60 1125000 OS/27/2020 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* ~ 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 Application, Terms and Conditions constitute the "Entire Maintenance <br />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 <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 />SI"d"~~::O:V~ Signature Date <br />12/29/2015 <br />Name Address <br />KITTITAS COUNTY st1f RI FF 5 OFI'Ie l: 307 UPTANUM RD <br />City I State Zip Code I E-mail Address Maintenance Plan Lienholder Name <br />ELLENSBURG WA 98926 <br />DEALERSHIP INFORMATION <br />Dealershio Sinna tdf'e ~L _-- <br />Dealer Name <br />Corwin Ford Tri-Cities <br />Address 1 Address 2 <br />1225 North Autoplex Way <br />City State <br />Pasco WA <br />Zip Code Telephone No FOR OFFICE USE ONLY <br />99301 <br />Employee Stars Id P&ACode <br />I 0 I 0 I 0 I 6 I 6 I 9 I 4 I 9 I 3 I I 0 I 6 I 4 I 6 I 7 I <br />ESP 8324 -MNTC (Oct 15) (Previous Editions May Not be Used)