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-MAINTENANCE PLAN APPLICATION, <br />TERMS & CONDITIONS <br />NEW AND USED VEHICLES <br />REGISTRATION INFORMATION <br />RECEIVEDtI� <br />JUN 012018 <br />�{ LINCOLN <br />KITTITAS COUNTY SHERIFF PROTECT <br />ACCOUNTING <br />Vehicle Identification Number "VIN" <br />17 Digits) <br />Signature Date <br />Warranty Start Date <br />Gas/Hybrid <br />Total Purchase <br />KITTITAS COUNTY <br />307 W UMPTANUM 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 />1 A <br />F <br />H P <br />2 <br />M <br />K <br />6 <br />J <br />G <br />1 1 7 <br />7 <br />9 <br />5 <br />06/06/2018 <br />03/16/2018 <br />Electric, CPO, BMP <br />Internet Sale <br />IPP Term <br />Current Mileage <br />Diesel <br />0 Yes 0 No 7 <br />❑ <br />10 <br />❑ Electric <br />Surcharges ❑ 12 Month/12,000 Miles (PMP Only - Not applicable for CPO) <br />El 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 BL or PMP CPO) <br />C] Incomplete <br />0 Specialty - Emergency (fire, ambulance, police (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 ENGINE MAINTENANCE PLANS : Gas/Hybrid and Diesel- (Standard $0 Deductible) <br />For Premium Maintenance Plans (PMP) coverage BEGINS at the New Vehicle Limited Warranty Start bate and Zero Miles, <br />Coverage ENDS at THE EARLIER OF the Number of Years Purchased, the Number of Miles Purchased or upon completion of <br />the Maximum Number of Service Intervals Purchased from the New Vehicle Limited Warranty Start Date or Zero Miles. <br />For LIMITED BASIC AND ENGINE Maintenance Plans coverage BEGINS at the Signature Date and Current Mileage, <br />Coverage ENbS at THE EARLIER OF the Number of Years Purchased, the Number of Miles Purchased or upon completion of <br />the Maximum Number of Service Intervals Purchased from the Signature Date or Current Mileage, <br />PLAN COVERAGE <br />Plan Name <br />Plan Term <br />Plan Expiration (Earlier of) <br />Purchase <br />Sales Tax <br />Total Purchase <br />KITTITAS COUNTY <br />307 W UMPTANUM RD <br />Months Mileage <br />Date <br />Mileage <br />Price <br />Maintenance Plan Lienholder Name <br />Price with Sales Tax <br />Premium Maintenance <br />98926 <br />72 <br />F100000 <br />03/16/2024 <br />100000 <br />$ 2680.00 <br />$ 222,44 <br />$ 2902.44 <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 />Plan Options <br />Electric, CPO, BMP <br />and EMP) <br />❑ Pick Up and Delivery Option (Lincoln only -excluding Fleet <br />vehicles) <br />Service Intervals <br />❑ 3,000* L^J 5,000 ❑ 7,500 ❑ 10,000+ <br />Service visits <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 />l acknowledge receipt of a complete copy of this Maintenance Plan (the A plication, Terms and Conditions constitute the "Entire <br />Maintenance Plan") at the time of signing and agree toall the terms andpconditions. I agree to maintain tne, covered 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 />MAINTENANCE PLAN/PURCHASER <br />Signature (Not Valid without Signature) <br />Signature Date <br />FOR OFFICE USE ONLY <br />06/06/2018 <br />Name <br />Address <br />KITTITAS COUNTY <br />307 W UMPTANUM RD <br />City <br />State <br />_ <br />Zip Code <br />E-mail Address <br />Maintenance Plan Lienholder Name <br />ELLENSBURG <br />WA <br />98926 <br />P&A Code <br />0 a 1 67 0 z <br />Ul :VA ■0:1+`l:IIJIkiIIs] _4iUhrIrel L1 <br />Dealership Signature <br />FOR OFFICE USE ONLY <br />Dealer Name <br />Columbia Ford, Inc. <br />Address 1 �Y <br />700 -7th Avenue <br />Address 2 <br />City <br />Longview <br />State <br />WA <br />Zip Code <br />98632 <br />Telephone No <br />Employee Stars Id <br />P&A Code <br />0 a 1 67 0 z <br />0 <br />2 4 <br />7 <br />7 <br />_ <br />5 <br />1 <br />4 <br />FPLP 8324 - MNTC (Oct 17) (Previous Editions May Not be Used) <br />