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MAINTENANCE PLAN APPLICATION, TERMS & CONDITIONS NEW AND USED VEHICLES REGISTRATION INFORMATION RECEIVED KITTfTAS COUNTY SHERIFF 11 at 4!00 1 T L11CoL11 PROTECT Vehicle Identification Number "VIN" 17 Digital 1 F M 5 K 8 A R 5 H G C 8 7 3 3 1' sighwow t J 07/13/2017 Warranty Start Date 05/30/2017 Q Gas/Hybrid Internet Sale IPP Term Current Mileage ❑ Diesel ❑ Yes X❑ No ❑ E� 5 ❑Electric Surcharges ❑ 12 Month/12,000 Miles (PMP Only - Not applicable for CPO) Zip Code 98632 36 months/36,000 miles (Ford and Competitive Make or 48 month/50,000 miles (Lincoln vehicles) (PMP Only - Not CPO applicable for CPO) ❑ Snow Plow (PMP Only - Not applicable for PMP E, PMP L, PMP BL or PMP CPO) ❑ Incomplete specialty - Emergency (fire, ambulance, all police pursuit units (except Ford Police Interceptor)), limo, livery, shuttle, tow trucks - (Gas/Hybrid, Diesel and Lincoln Premium Maintenance Plans Only) ❑ Medium Duty PREMIUM MAINTENANCE PLANS: Gas/Hybrid, Electric, Diesel, Lincoln, Black Label, Incomplete (Cab/Chassis), Medium Duty, CPO - (Standard $0 Deductible) LIMITED, BASIC AND ENGINE MAINTENANCE PLANS • Gas/Hybrid and Diesel- [Standard $0 Deductible For Premium Maintenance Plans (PMP) coverage BEGINS at the New Vehicle Limited Warrant Start bate and Zero Miles. Coverage ENDS at THE EARLIER OF the Number of Years Purchased, the Number of Miles Purc ased 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 Mires Purchased or upon completion of the Maximum Number of Service Intervals Purchased from the Signature Date or Current Mileage. PLAN COVERAGE Plan Name Plan Term Plan Expiration (Earlier of) Purchase Total Purchase Months Mileage Date Mileage Price Sales Tax Price with Sales Tax Premium Maintenance 72 100000 05/30/2023 100000 $ 2680.00 $ 225.12 $ 2905.12 Premium Maintenance ❑ First Day Rental (Not applicable on Black Label 2016 Model Maintenance j [:]Full Synthetic Oil (Not applicable on fully Plan Options Years and Prior, Incomplete or Medium Duty Plans} Plan Options Electric, CPO, BMP and EMP) ❑ Pick 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 20 DISCLOSURE INFORMATION NOTE: THE PURCHASE OF THIS MAINTENANCE PLAN IS NOT REQUIRED IN ORDER TO PURCHASE, OR OBTAIN FINANCING FOR A MOTOR VEHICLE. Vcknowledge receipt of a complete copy of this Maintenance Plan (the A plica#ion, Terms and Conditions constitute the "Entire aintenance Plan') at the time of signing and agree toall the terms anclocond►(ions. 1 agree to main ain the coverer! vehicle in accordance with the manufacturer's stated periodic maintenance recommendations as a condition oto receiving coverage under this Maintenance Plan except as otherwise provided by law. MAINTENANCE PLAN/PURCHASER Signature (td d thout Signature) Signature Date r� / )741312017 Name Address KITTITAS COUNTY 307 W UMPTANIUM RD City State Zip Code E-mail Address Maintenance Plan Lienholder Name ELLENSBURG WA 98926 NONE �I��.{►�il1i111�2*1►+1Lr1I�rIIi•]► Dealership Signature __--� ---•• --- FOR OFFICE USE ONLY Dealer Name Columbia Ford, Inc. Address 1 700 -7th Avenue —dit-Y Address 2 Longview State WA Zip Code 98632 Telephone No Employee Stars Id P&A Code [ 0 1 8 6 0= >�, 0 1 0 1 2 1 4 7 7 :5]71774 L_ ESP 8324 - MNTC (Oct 16) (Previous Editions May Not be Used)