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RESOLUTION 2013-740 s ADOPTED DOC ID: 9141 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-740 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 8, 2013: RESOVED that the Town Board of the Town of Southold hereby amends Resolution No. 2013-380 as follows: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute a Motor Vehicle lease agreement with Nissan Motor Acceptance Corporation in connection with athree-year lease for one Nissan Leaf for the Human Resource Center in an amount not to exceed ~1-100 $12,000, which shall be a legal charge to A.6772.4.400.800 over the lease term, subject to the approval of the Town Attorney. E?,Q. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER: William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell dt: SignatYleONE" NISSAN MOTOR ACCEPTANCE CORPORATION 5 MOTOR VEHICLE LEASE AGREEMENT WITH ARBITRATION CLAUSE -SINGLE PAYMENT -NEW YORK Lessor' RIVERHEAD AUTO MALI LTD. (631}369-060@ 10/21/20_13 NhNE OP L2titiOR IDEdLCNI LtlS~ON I LL[PHO V L: NI T1HFH LfiASP. DAT2 _1800 OLD COUNTRY RD RIVERHEAD NY 11901 - - l I HL1'I' ADIJHFSS CITY ~TATE_ LIP CODC NMAC DFALP.R ~I MHEk Lessee f> Co-Lessee TOWN OF SOUTHOLD N A V AME OP LhSSEC N4MY OY CO-LPStiCF FAMH OF DRIVER (IF 11 S)FF IS A NUtiISP.SS) 53095 RTE 25 SOUTHOLD NY SUFFOLK 11971 I I »FF STNFFT ADU26ti5 CI IY 11AYE. COLYIY' LIP CODE N/A N/A N/A _ ICSSFP. MAIIJ]G AUDIthSti (IF UIPYEIiL'.A'1~ YNOM AUOV EI Ol}' PT4TE CDI']9Y ].IP CUDE N/A N/A NJ!1_ VLIIICLF GPItdGIAt 1DDRF.A [IF DIYYPNPN'I PNO~~I A14OAq'J CIIY SIAI'[. C(Il~NR' %IP CODF. 'You` and ~)~om`~ rc far equally to the Lessee and Co-Lessee (if anyl signing chic Lease. "We,"'us" and 'our` refer [o [he llcaler, ro Nise-an-Infiniti CI' ("NILT') and any otlter assignee, if this Lease is avcigned. "Vehicle" refers [o [he Motor Vehicle deso~ibed below, including attachments, equipment, the battery and accessories, including any charging accessories included with the vehicle You agree to lease this Vehicle from us under the [anus on the front and back of this Lease. You understand that this is a Lease You do not own this Vehicle, unless and until you exercise your option to purchase this Vehicle. Yenx mnri¢ moDr~. noDC sn~.e vema.E mrrvT~P~canon rvi~s~nEa o~in~ 2013 NISSAN LEAF 4DS0 1 N 4 A Z 0 C P 9 D _C 4 1 8 1 6 5 j~Vew PY[YYLCLty tJSe ~(:ommerdal ? Personal. Family or household 13 GY ?Cha[ging A<ecscodes µipµryhyG lmporlmrt consumeeprotedioasmay not apply ifthu Lease indicates that ?Used oDOMetYx xenowc corow~cer cone. the Vehideis being leased primaNly for agrieuharal, business or commercial use. AMOUNTDUE LEAS6'YdYMEN'7' 077-IFR CHARGA,S*(Notpan ofvoterleasepayment) TOTdL OF dL'LEASE One payment of PAYMEN7"S SIGNING OR a) Disposition Fee (if you do not ~ 18719.28is due on signing. purchase the Vehicle) 395.00 (1'he amount you DELIVERY will have paid by The total of your Icase payment N/A + S N/A the end of the (From Section 4, due in advance is 5 7 8719.28. Lease) itemized below) NIA + g NLA d) Total - S 395.00 19806.78 3 -__19411,78 'bt add!liari. lnu main batr ro pay excess urar and icse rutAn~ileage_ !f arn~. AMO(INTDIIIiATLP.ASF. SIGMNG OR OH.'LIVSRY ~ N/A NJA a) Capitalized Cost Reduction including any net trade-in allowance S NJA U N/A N/A h) Lease Rayment +S 18719.28 m) NY TIRE FEE +5 12.50 c) KefundaMe Security Deposit + S NJA n) NJA ~ S NJA d) Title Fees +S N/A__ o) 7btaL 19411.78 e) Registration Fees + $ 10.00 D Tax on Capitalized Cost Reduction+$_ NJA HOW7NC AMOUNTD(16 ATLNr1SE SIGMNG OR DtiLIVERY WILL Bti PrllD g) Sales Tax Paid in Advance + $ N/A I) Net 9'rade-In Allowance $ NJA h) N/A N/A ll) Rebates and Non-Cash Credits +y 8150.00 i) AC[1 F FF + $ 595.00 RD Amount To Be Yaid in Cash + $ 11261 .78 p rw• ccc +g 75.00 IV) Total 19411.78 _ a) Gross Capitalized Cost. e) Depreciation and Any Amortized The agreed upon value of the Vehicle Amounts. The amount charged for ~t t~~~oo.•_-a a[r and any items you the Vehicle's decline in value through pay for in the Lease such as taxes, normal use and for other items paid fees, service contracts, insurance for in the Lease. = 18672.00 ~ and any outstanding prior cmdit or lease balance. Ylease see Section 8 ~ Rent Charge. The amount charged for itemization of [his amount. $ _911Tad_>3~-. in addition to the depreciation and any amortized amounts. + 47.28 b) Capitalized Gost Reduction. The amount of any net trade-in allowance, g) Total Base Cease Payment. rebate, non~ash credit or cash The depreciation and any amortized you pay the[ reduces the gross amounts plus the rem charge. = 18719.28 capitalized cost. - N/A/'t' h) The Number of payments in 1 ~ Your Lease ~ c) Adjusted Capitalized Cost. The - amoaN used in calculating your ¢ i) Base Lease Payment ~ _ t R71 Q _ 9R base monthly payment = 311 9N-~ j) Sales, Use or Lease Tax + Nrl4 d) Residual Value. The value of the Vehicle at the end of [he Lease used in k) Luxury Tax + NIA calculating your base monthly payment- 79A4R_OIOi p Total lxase Payment = $ 1R719_2E Early Termination. You may have to pay a substantial charge rents per mile, which is included in the lease payment. There if you end this Lease early. The charge may be up to several will be no refund for unused miles, including any additional miles thousand dollars. The actual charge will depend on when the purchased by you. Lease u terminated. The earlier you end the Lease, the greater purchase Option at End of Lease Term. You have an option to pur- this charge is likely to be. See Section 15. chase the Vehicle at [he end of the lease term for 5 12448.00 Excessive Wear and Use. You may be charged for excessive wear and a Purchase Option Fee of $300.00. See Section ]6. based on our atxudards for normal use and for mileage in excess Other Important Terms. This Lease contains additional information of ~woaru>rniles per year at the rate of cents per mile on earty termination, purchase options and maintenance responsi- Sec Section 21. ?If this box is checked, this mileage includes bilities, warrantless, default charges, insurance, and any security ~ ppiles over the term of the Lease purchased at -jr fq imerest, if applirAble. ~ _ I a) Capitalized Cos[ ~ $ 0~ The estimated rotal amount you will pay for official and license (The sum of the adjusted capitalized cast and dte capitalized ms[ reduttion e fees, registration, title and [axes, including personal property [axes, apinlized cost and the amount of rental payment may be negotiable-) over the term of your Lease, whether included with [he lease h) Capitalized Cost Reduction - ~ ~ f~_ payment or assessed otherwise is $ two e~ he actual [o[aL (cash dowopaymem plus net wide-in value) d (ees and [axes may be higher or lower depending on [he [ax c) Adjusted Capitalized Cos[ rates in effect or [he value of [hc leased property a[ [he time a fee (The amount which is apiialized in conacYVOn wldr this Icase and is s M or tax is assessed. the amount u(your (xnudic payanent This amount will be used in daermining the Ieial limit of tour early terminahun liability-_ Alilungh the'adjuxled capitalized cost` is not re(crred to in [he cadt tenl~ination prudsons of This Lease, the 5tdjuged capitaized W9" may he used to compare the early termination provisions of competing lessors) 't'hese products are not required to enter into [his Lease and will no[ d) Ps[imated Residual Value $ be provided unless you sign below. If insurance, coverages and/or warranties are purchased by you, these are shown in a notice given - ~ ~ ~ [o you on [his dale. These products may not be available in some The following items you will pay for in the pease and are in the lease paymenC states' a) Agreed upon value of the Vehicle S ~T_1Z0_~ a) Mechanuul Breukctoum ProteWaon $ h) Up-Front Sales Tax, if applicable + ~r~ 1 ~ cc uanc~~ ~ ~ .4~ , c) Titie,Licedst~asdliggistiatiori _ ~ - a (Covers pans o6Vehtc~e~i }S.to so0rief o~qT T miles). d) Acquisition Fee + ~ e) Service Contract(s) and/or L ~ ~e Maintenance Contract(s) (See Section 12) + va. ~ - reuse~~Ar-,~i~ ra.nddtFih]ts I f) Prior Creditor Lease Balance + _ ~ E> + b) Maintenance Contract $ ,_F; i i h) + ~~k vac~fi3~ u r mrewln`~h1Gh, ~ i) NSA + NSA r,;i :r I k) Tot Gross Capitalized Gost - , t""tt "I'he sdteduled term of your Lease is months. 'u` n„r~r ~i"~ r~~~~'.i 't'his Vehicle is covered by any warranty, extended warranty, d) $ cun~me service contract or maintenance contract indicated below ~ Stzndard dew Vehicle Limited Warranty provided by the ?X7(manufacmrer or distdbu[or of Chia Vehicle vx< - rmrx au n~ , ? Mechanical Breakdown Protection (MBY), a service contract for [he re pairs of certain major mechanical breakdowns of this Vchic~c and related expenses e) _ $ ? Maintenance Contract a contract for regularly scheduled care ouecc and maintenance of [his Vehicle ? Used Vehicle Limited Warranty -vxc - u~srt rutvst. L EXCEPT ABI~RESSLY PR0~7UPD USDER TH15 IF.ASE, WL OPFER NO EXPRESS OR 141PLIED WARItAV HES WITH RFSPCCT TO THIS VEHICLE. WE 17AKE 90 IMPLIED 7o6a1 Pre rrzium.?Charges $ IIARRiVTY OF t1ERCHAXTAl3IlIT5. THE LESSOR UVDF.RT4KES VO RESPOVSI6ILITY FOR THE QUALITY OF THE GOODS EXCEPT AS OTHERWISE PROVIDED ID' THIS COVTRACC'IliE LESSOR ASSGMES M1O RF.SPOVSIB[LITY THAT THE GOODS WILL RF. FI'I FOR AX'Y PARTICGLAR PURPOSE FOR WHICH YOG MAY BE LEASING THESE GOODS. EXCEPT AS OTHERWISE PROb9UED Iti THE COV'1'ItACI'. ~itr~3oo t-ip-~r tone LESSEE j na~gP~,nJ ay lliv ,w~a np 'wo~a uv, c, araytll 1 at5a nl n` IP.; ]p0111111L 1D.ailulu] ]IIn,dJJl ylllhJCll,Jdlr ~l l~~l ~~]II XI~I 1r~Jlp3VVIIp UIm1~ I~~~IP.~~I I,LV]IIIJH~I?~1I,d1AS1yYltll.i AfIPJU~tp AI ~~~IO flllt-tWal Tla~ I A I I IllIY It%, II' I I I { I ayi tiuq inicr>u ql „Pnunaitiv.uaw„~ Im npion ,alun a~ru~atsup ~hry nq~iu ou ui t,nnpap aaYc nm lamp ~~~I rpn~a~a n:ai,ao,„meRui rtyaay7 in7iuap~imo uopm:yc.n,p i~nya,uinoala ueaud lP 9Z uolraaS ui pasopnp sluuourc ayl'llne]ap m, aye non p, UII Iny'g uopaty to pno~nlp'rwal away palnpayw nroe ui syluuw pi ralwnu ayl n4 papinip 11 c uoiP.>S m p~>`opnp wld _su.3lP tpam~c la.l loo syiuouyo nmowe aylm luamnnd,(ppurnn std put ~ob'tant avva~aip,lo puaay~la'd apnlaq cap io nnicvacsod daar,nrn)I :.nluw iath..rw!1l nvarail4mi dq nw nn wi, xva'nto(it loatuirr ,awe vlo ntolNtn iv a „v~~t rapaJ,wp nnh uogcmuo llt 1'.a~µu5a~n~ni iq~l,~iiam~i r,~rp~JmoJ~~ixnnt yinds d~wopcxr~ I I I I I J.-. a I ~ I ~ I 71 I P ~ P I r tpo is rap:.ii m „p r a~aryar np unlm pp. r¢ pr~npryas sr. ro ~pu nipsp, carewuu.,i ni:a~ mu. uai~ par Ohl i(nn iselagou,luaui h:das~:a~.p~pinw aypluoegrym al lenba aXreya uonemuaa.6^Voi 2[.LYl 8 8 ~Z a v. ~t uoiUaS spun an rlvgl arvigim,t loo op anp an an~ci alrssa~oy;prar„nlVU RnpnlainT ~ ~ 1 ~ l)] suoriipuo~ pat; smda,~ wuo9!PPV NEIL' YC1RK T~iSCLOSLrR.e. ST'STEh1RN7 NEIL' C.4R LEMO.'s~ LAW BILL OF RIGHTS (1) In addition to any warranties offered by the manufacturer, your new car is warranted against all material defects for eighteen thousand miles (18,000) or two (2) years, whichever comes fu•s t. (2) Xou must repos-t any problems to the manufacturer, its agent, or authorized dealer. (3) Upon notification, Une problem must be corrected free of charge. ' (4) If the same problem cannot be repaired after four (4) or more attempts; or if your car is out of service to repair a problem for a total of thirty (30) days during the warranty period; or it the manufacturer or its agent refuses to repair a substantial defect or condition within twenty (20) days of receipt of notice sent .by you to the manufacturer by cer[iAed mall, return receipt requested; then you may be entitled to either a comparable car or a refund of your prrchase price, plus license and registration fees, minus a mileage allowance only if the vehicle has been driven more than 12,000 miles. (5) A manufacturer may deny fiabillty if the problem Ls caused by abuse, neglect, or unauthorized modifications of the caz. (6) A manufacturer may refuse to exchange a comparable caz or refund your purchase price 1f the problem does not substantially impair the value of your caa. , (7) if a manufacturer has established an arbitration procedure, the manufacturer may refuse to exchange a compazable car or refund your purchase price untll you first resort to [he procedure. , (8) If the manufacturer does not have an arbitration procedure, you may resort to any remedy by law and may be entitled to your attorneys fees if you prevail. (9) No contract or agreement can void any of these rights. (10) As an alternative to the arbitration procedure made available through tine manufacturer, you may instead choose to submit your claim to an In¢ependenC arbitrator, approved by the Attorney General. Xou may have to pay a fee for such an arbitration. Contact your local consumer office or Attorney Generals office to fmd out how to arraange for independent arbitration. M\ / Or1 New York State Department of Motor Vehicles Batch V~UG=`~ ~~`S=. VEHICLE REGISTRATION/TITLE APPLICATION F°e N° - ? Orig ? Acu'vity ? Renewal ? Lease Buyout This form is available at www.dmv.ny.gov ? Dnp ? Ach~ny wIRR ? Renew w/RR ? setae Tax wRn Tule e Old Old 3 0l Ins- Co. Exp. Plata Class Neme Gode Dale Scofflaw Case New New Number(s) Plata Clese Special AT BV CF CO CP EX FL GI IF MO NE NF NR NU OD OP OV PA , Contlitions PL PK RC RE SA 50 SR 55 SV TE TL TO TP TR TX XR X6 WO Sales Tax $IdWS Value Juristlitlicn Rale Out of Stale Audii ' • Information r Diu clew issue plates to this Plate Reg. Glass Dale Tomp Issued Facility ID Number Is there a lienholtlerl D Ves o Ir"Vas'. y Number enter the inrorma[icn in Dealer Only Dox below. ~ Yea ?XNO FAS 7042963 • COMPLETE 0©OQ' antl Q . WHEN ~ AND APPLY, COMPLETE THOSE SECTIONS. PRINT CLEARLY /N -I BLUE OR BLACK~NK~~J O MARK THE BOX OF THE TYPE OF SERVICE YOU NEED. (For more information. rater to form MV-82 L aRegisteringTitling a Vehicle in New York State"J ? A FIRST REGISTRATION for this vehicle ? CHANGE a title (refer to ?5 ) ? REGISTER a vehicle that I registered before ? Gel a TITLE ONLY fora 1973 or newer vehicle If you mark one of the options below, write the PLATE NUMBER here ? RENEW a Registration ? CHANGE a Registration (refer to~5 ) REPLACE loss registration items ? TRANSFER a Plate Number ? Purchased my LEASED VEHICLE You can update the address on your registration and renew your registration online al www dmv nv eov. © r of PRIMARY SEX DATE OF BIRTH TOWN OFM SOUTHOLD NT (Last First Middle NYS i rive; he se numbel - I ~ ~ LJL 1 - - ~ r M F ~Monm oay Ve. NAME OF CO-REGISTRANT (Last First MidtlleJ _ NY_S driver Ilcense number of CO REGISTRANT SEX DATE_lOF BI~I _ - Ir_ l ~ ~ O Month Day V a DAYTELEPHONE(OptionaQ NAME CHANGEZ ~ ADDRESS CHANGEr - Is (his re lstralion for a cor oration How did ou et ~(-g Area Coda g P 1 ~ Y 9 ?New OLeased New ? YES (refer to?6 I 13DSkG _ ? YES ~DSJ~ or partnership? C~y'es ? No J the vehicle? ( ) ~ J _ , _ (mark one) OUsed ?Leas_ed Used THE ADDRESS WHERE PRIMARY REGISTRANT GETS MAIL (Include Steel plumber and Name R rat Delrveryo box number ihis address will be on the document ) Apl No. Qty or Town Slate Zip COtle County of Residence 53095 RTE 25 _ ~ SOUTHOLD ~ N1 Y 11971 SUFFOLK - THE ADDRESS WHERE PRIMARY REGISTRANT RESIDES IF DIFFERENT FROM THE MAILING ADDRESS. (DO Noi GIVEAP.O. BOX.) Apt No. Crty or Town - State Zip Code L DRIVER LICENSE NUMBER OF OWNER The owner o/the vehicle must sign this section. NOTE: Do riot complete this section i/ a completetl Registration Author(zat/on (form MV-95J is attached or i/ you apply to renew a vehicle registrat(on and the owner o/ that vehicle has not NAME OF CURRENT GWNER(Lesf, First, Middle) changed. Proof of ownership and proof of owner's name and date of birth are required. NISSAN-INFINITI LT; NILT INC, TRUSTEE ~ DAV rELEPHDNE NUMBER OF GATE OF BIRTH OWNER. (Optional) _ Month II Day Vear l~/Area Code - _l THE ADDRESS WHERE OWNER GETS MAIL wl°,al oeu~slreal NV ueereee Hame, n errorn mean _ Apt No Qty Town State Zip Code C unty PO 80X 254648 LACRAMENTO ~C ,t 95865 46481 l AUTHORIZATION: The regi t c - ed in ©is authorized to register the vehicle described in 0. 10/21/2013 lgnature of owner or authorized person, and signature oleo-owner it applicable) (Date) O VEHICLE IDENTIFICATION NUMBER VEHICLE DESCRIPTION Body Type For Cars (mark one) (Year Make I _ _ 1N4AZ0CP9DC418165 2013 NISSAN ~ ?2-DoerfrO0 sratonwagonor ?other _ _ sAM-Door ? Convertible ?SUburban _ _ Body Type For Other Vehicles (mark one) Type o/Power (Fuel) - rLOlor I llnlatlen Wel9ht- - ~Prck P?Van ?MOtomycle ?TO ?Trailer DOther 111 ,yYyy I Truck Tmck GY 3256 J ? Gas ? Diesel 17Rlectric ? Flex ? CNG ? Propane ? None 1 - - _ - _ 1 iC lind For trailers 8 commercial vehicles For rentals buses 5 taxis - Does the ODOMETER display 5, 6 or 7 F com_ n_erc al eh des rs ( Maximum Gross Weight Seating Capacity i Otlometer Reatling in Miles i _ nvmbersz (write the number do not Axle Distance L . 5 13 include tenths) 6 ' Lien Filing Cotle Llenhol0er Name and , (Assigned Mallln9 Address a by DMV) I l f41 9. B d P- ~ i.. ~ I~~ 1~1 r ~ 1 1 x~ - ~ P S bm nvd Name a ~tl Ownereh oiRi s~onse ( W 1o rmc.. Sta . au - l i Dale IUId P n d ~~ae r ~ tpealrr - - MV-82(8112 - PAGE 1 OF 2 CHANGES - INnte ne~a infoh~~ation abot c~lrert reps un o, tic ~ ;aye 1 of this form (forrnore information, refer to form MV-82 f. 'Registering/Titling e Vehic-;e in New Ynr,k State-.) NAME CHANGE Print the former name exactly like fhe /ornler'narne .tinted on the current regis6ation or title- CHANGES Describe any vehicle changes and the reasons /or the changes. _ Q ADDITIONAL VEHICLE INFORMATION QUESTIONS 1-3 MUST BE COMPLETED. 1. I certify that, to the best of of my knowledge, this vehicle ? has been or as not been wrecked, destroyed or damaged to such an extent that the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal operation on the road or highways, is mare than 75 % of the retail value of the vehicle at the time of loss.(Checking the "has been" box means the vehicle must have an anti-thek examination before being registered, and that the title issued will have the statement "Rebuilt Salvage" on it.) 2 Is this vehicle registered for your personal use? ? Yes C~Ji Nc I(you marked "Yes", go to the next question (question 3) 1(you marked "No", check any of these boxes [hat apply: ? This vehicle is a passenger vehlcle that will be used for hire with e driver and will be operated In the following location(s): ? New York City (NYG) ? A ]unsdiction that Is not NYC that regulates taxis ? A jurisdiction that tloes not regulate taxis ? Thls vehicle Is a passenger vehlcle that is rented without a driller. ? This vehicle requires a permit for commercial operation. (Mark the box of the type of permit that was issued and write the permit number on the line.) ? NYS DOT Permit No. ? Federal DOT Permit No. The government owns this vehicle. ? This vehicle is used as (mark one) ? an ambulance ? an ambulette ? a hearse or invalid coach If payment is received to carry passengers, mark this hox. ? ? This vehicle is used exclusively as a hearse If payment is received to carry passengers, mark this box.? ? This vehicle is a commercial tow truck with a gross vehicle weight rating of at least 8,600 pounds. ? This vehicle is used only as a farm vehicle. (form MV-260F, Part 1, must be attached) ? This vehicle is used only as an agricultural truck. ? This vehicle is subject to the Department of Transportation inspection requirements for the carriers that transport passengers. (For more information, refer to form MV-32.1P, "Inspection Requirements for Carriers Transporting Passengers'.) yam- N/A 3. Has this vehicle been modified to change its registration class? ? Yes CI~ No If "Yes", explain N/A _ _ 4. This vehicle is a pick-up truck with an unladen weight that is amaximum of 5,~~ ounds. This vehicle is never used for commercial purposes and does not have advertising on any part of it. I want (mark one): EY Passen er Plates ? Commercial Plates CERTIFICATION: The information I have given on this application is true to the best of my knowledge. I certify that the vehicle is fully equipped as required by the Vehicle and Traffic Law, and has passed the required New York State inspection within the past 72 months, or has qualifed for a time extension (Form VS-1077) and will be inspected within 10 days. I also certify that appropriate insurance coverage is in effect, and that the vehicle will be operated in accordance with the Vehicle and Traffic Law. If I am applying for replacement registration items, I ce ~ that the registration is not currently under suspension or revocation. If I have plates in a series reserved for a special group, I certify that I am still ible to receive them, and that I have only one set of these plates. If 1 am using a credit card for payment of any fees in connection with application, 1 understand that my signature below also authorizes use of my credit card. Print Name Here ~ TOWN OF SOUTHOLD Sign Here (Print Name In Foll - I(regislaring for a rgrporatioq print your lull name en0 Nle) ~ (SiBn Here) Print Additional N A Additional Signaturg N/A Name Here ~ / Sign Here 11 (Pool Name In Ful1J (Sign Here -Adtllflonal signature required /or a pertnershlp or i/registering this vehicle in more than one name.) IMPORTANT: Making a false statement in any registration application or in any proof or statements in connection with it, or deceiving or substituting in connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in the revocation or suspension of the registration pursuant to regulations established by the Commissioner. The Department makes no representation that it will issue a certificate of title or transferable registration until the Commissioner is satisfied that the applicant is entitled to a certificate of title or transferable registration, and until all documentation required to establish ownership of the vehicle is submitted and deemed to be satisfactory. Pending review of this application, neither the Commissioner of the Department of Motor Vehicles nor any of his or her employees, deputies or agents assumes any liability or responsibility for repairs performed, improvements made or work done to the vehicle referenced in this application. CREDIT CARD AUTHORIZATION IF CARDHOLDER IS NOT THE APPLICANT: My signature authorizes _ to use my credit card for payment of fees in connection with this application, Sign and I understand that I must be present for this transaction. Here (cardnoider-sign Name in wo) A- ! - Lien Filing Code (ASSlgned by oMV) _ Lienholder Name Mailing Address _ INUmber a,tl Street) (GM1y) (State) Rip Code) Lien Piling Code W~sig y by om~.v, _ _ ~nholder Name i NY DEALER rEFtT l~l^AT3Ohl I .v I ~ I t{i ~ _~4"~ S~.~A..~~~(y~j. - ~true. I tarcE I pl s JI y c ,.a i i I ' ~ r iti. r., ~,e s,4r.,u orocamr or „rc, t. '.~2 a rnv-az ;©nzl _....~.-.,rv_.w_..._ .,am..-~.__ PAGE 2 OF 2 ""°""•~„s New York State Department of Motor Vehicles MV-653 (7/07) ° CERTIFICATION OF ELIGIBILITY FOR GOVERNMENT/OFFICIAL PLATES ATTENTION: This form is to be used only by NYS political subdivisions to certify eligibility for Government/O~cial plates. A political subdivision is defined as a subdivision of New York State that has been delegated certain official functions of state or local govennment, including a govenunent entity created by, or under the authority of, State law. A vehicle assigned GoverrnnenUOfficial plates must be owned or controlled by a political subdivision and operated by its employees, or specifically designated agents thereof, in the course of their official duties. The vehicle must be titled and/or registered in the name of the political subdivision. PLEASE CHECK THE APPROPRIATE BOX BELOW TO INDICATE YOUR OFFICIAL GOVERNMENT STATUS: GOVERNMENT DIVISION, DISTRICT OR OTHER GOVERNMENT ENTITY: ? State of New York ? City ? Village ? Fire District ? County ©Town ? School District ? Other Government Entity Name of NYS Agency, County, City, Town, Village, District or Other Government Entity Town of Southold Department or Division Human Services Address 53095 Route 25, PO Box 1179, Southold, NY 1197I-0959 Name of Department or Division Director Business Phone Business E-Mail Address (Optional) Karen PlcLaughlin ~ 631-298-t?~+60 karen.mclaughlin@town.southold.n .ue DESCRIPTION OF VEHICLE~S~: ? Check this box if you are certifying multiple vehicles, and attach a separate sheet listing the requested information for all vehicles. Vear Make Model 2013 Nissan Leaf Vehicle ID # (VIN) Plate Number (it currently registered) 1N4AZOCP9DC418165 ypwW [j,) ~v } I certify that the above-described vehicle(s) is (are) owned or controlled by the political subdivision Co which this application for registration applies, and that the information contained herein is true and accurate. I do so in my capacity as a duly appointed public officer or official who has been granted [he authority to act in the above-stated agency's behalf. f understand [ha[ knowingly making a fals statement on an application submitted to the Commissioner of Motor Vehicles is a misdemeanor under Vehicle and Traffic Law, a mis eanor or felony under New York State Penal Law, and may result in criminal prosecution in addition to revocation or suspension a registratio pursuant to regulations promulgated by [he Commissioner of Motor Vehicles. Signature ~ Date: October 21. 2013 (Sign Your Name in Full) Print Your Name: Scott Russell Title: Supervisor Address: City: Zip Code: Your Business Your Business Phone number ( ) E-Mail Address (optional): DMV Supervisor Approval: Authorization Cade (Initials) ? Code from List Date: ? Code from CO • (Print CO Supervisor's Name) , _ ~ c~ DnrE,~EP1"EMBER 25, 2013 INVOICE NO. 659297-26 VEHICLE IDENTIFICATION NO. YEAR MAKE I.IV4AZOCPgDC-4i>316s 2013 NISSAN BODV TYPE SHIPPING WEIGHT PJi'--;P,{~1 t_Ai= 5--I7i:JC)N 325b H. P. OV W.R. NO'. CVLS. SERIES OR MODEL i.Ci:y 4:!'x'3 NrA iN4AZOCP9DC ~ r 5U S"IAIE EM:[S4;ION~ E(~UTPPED VEHICLE. MAY BE r30LD AND REC>ISTFRED A`3 P>fEW VEHICLE IN ANY 57ATE OF THE U. S. I, theundersigned^:authorized representative of the. company, firm or corporatiap'named below, hereby cer- I tifyiihat the newyehicle described 'above Is the property of the said company, firm or corporation and is i transferred on the above date and under the Invoice Number indicated to the following distributor or dealer. NAME OF-0ISTRIBUTOR;DEALER, ETC. r VALUE CITY F~,UTO GROUP LLC d/h/<a NISSAPI OF GARDEN CITY Sib N FRANKLIN,ST I ~ p, t HEt'iP57E11~~AD NY i i 550 It I~~~fi~rther cerC~'I~~) that this was 1h~ first [rarli$f~~,r of such new ~rehicle in o~ir{~ry trade and craKhmerce ' NISSAN PI~JRTH AMERICA, INC. ' lilt - Bv: N 2 4 6 2 4 8 4 i LI (SIGNATURE (~Fi{(UTHORIZE REPRESENTATIVE) (AGENT) 2 n. 1i3~?b804982 - '5036 FRANKLIN, TENNESSEE 17013 arv - r~TE 1 ` P F S E New York State Department of Motor Vehicles VIII III III VIII VIII VIII VIII VIII VIIIIIIIIIII IIII ? OLESALE OR ? RErna: RETAIL CERTIFICATE OF SALE ? Used ? Demo ? Salvage 4 5 9 6 0 3 8 2 VEHICLE INFORMATION: No. 4 5 9 6 0 3 8 2 Vear Make Model Body Type Color Weight (Unladen) Fuel Cylinders Adult ' ; LEAF 4DSC GY 325F type. - 0 capeary Vehicle Identification Number Lien(s) Inspection Certificate Number Date of Inspection L Insptsctipn Statign..NUmber 1 N 4 R `C 4 5 L NA N/A 71x1594 Plate/PermM.NUSMter Numbai ofDealer Plate Loanetl ? Lease Buyout Selling Price NA N A pnsp.NOtRequired) S N/A DEALER INFORMATION (Pont Name and Address) 3 f, N. FRANY,LIN ST HE4IPSTEAD NY 11550 PURCHASER INFORMATION (Print Name and Address) Date or sale 12iJ04f^013 ivr T IA TD D Dlter 4CAr? \IV t R ERHEAD AU~OttALL 1800 OLD rpl•J .Y R ~Rr~ 1190, PRIOR OWNER INFORMATION (Print Name and Address Source ofOwnership) Date of Purchase CJiSSAN NORTH ANERICA FRANk:LIN TN 10;'P,1j20i3 ODOMETER DISCLOSURE STATEMENT Federal and state laws require that youstate the mileage of the vehicle described on this certificate, when transferring. ownership. Failure to do so, or not felling the truth about the mileage may result in fines and/or imprisonment. The odometer on [he vehicle describedabove has: Q 5 digits ~~digits, not including tenths ODOMETER READING ? 1 dEi{ify that, to [he best of my knowledge, this odometer reading reflects the "ACTUAL MILEAGE" of the vetucle described above. e. ? 1 certify that, to the best of my knowledge, [his odometer reading "EXCEEDS MECHANICAL LIMITS." (rro tenths) ? 1 certify that, to the best of my knowledge, this odometer reading is "NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY." DEALER CERTIFICATION: 1 certify: The vetdcle described above sold to purcha on the date indicated. At the ume of delivery Ne purchaxr was entitled to register the vehicle. This vehicle complied vrith equipment s n6 of C ~ si is abons. h time of livery, such equipment was in condition and repa'v to render saasfamory and adequate service on the public highway antler normal use. w s ti oes a eNC nolA as ne wholesale, or salvage. All New York State and local Uxea due as a insult of [Isis sale have been collected tram the purchaxr. Falx uam t .d5 of d¢ Rnallaw. EALE (w } ( N Idll nom PRINT full name tN dealer or authorized rep. Date Dealer 121/04/2 ~3ciliry NISSAN OF GARDEN (:ITY No. 7101594 PU GNfull na PRINT full name of purchaser Date Sellirsp 10/04/2 p3aler RIVERHEAD AUTO^1ALL NvSSales 2213f°[3_'.7'3 Tax No. My-so loaroal ANY CHANGE OR ALTERATION VOIDS THIS CERTIFICATE SignatuireBUSINESS~" NISSAN MOTOR ACCEPTANCE CORPORATION ® BORROWING RESOLUTION FOR BUSINESS CONTRACTS (Corporations/Partnerships/Limited Liability Companies) "RESOLVED, that any Supervisor [official's titles, such as president, vice president, treasurer, secretary, general partner, member or manager] of this Town [business entity type, for example, Corporation, Partnership or Limited Liability Company] are hereby authorized, in the name of this organization, to enter into any one or more Vehicle Lease Agreements, Fleet Lease Agreements, Conditional Sales Contracts, Security Agreements, Chattel Mortgages, Retail Installment Contracts and Motor Vehicle Contracts or similar documents with Nissan Motor Acceptance Corporation, Nissan-Infiniti LT, their affiliates, their assigns, their predecessors-in-interest, and/or any party that has assigned or intends to assign their receivables, contracts, leases or similar documents to them (hereinafter referred to as the "Other Party") with or without security, to execute and deliver such aforementioned agreements and instruments and any related documents, instruments or certificates in the name of and on behalf of this organization, in such sums, upon such terms and as often as such authorized signers deem advisable. The authority given in this resolution shall be deemed to be retroactive, and all acts performed prior to the passage of this resolution are hereby ratified and affirmed. The authority herein conferred shall continue in full force and effect until written notice of its revocation shall actually be received by the Other Party at its headquarters office or by its assignee at the headquarters office of the assignee. The Other Party is free to assign any of the obligations to any assignee of its choice without notice, and this organization shall continue to be fully bound to any assignee." I Elizabeth A. Neville [undersigned's name], Town Clerk [business title, for example, Secretary, General Partner or Managing Member] of the Tnwn of Smlthn7 d [this organization's legal name] hereby certify that this organization is formed under the laws of the State of New York ,and that the above is a true copy of a resolution properly and legally adopted by the Board of Directors, Members or Partners of this organization at a properly convened meeting of this body held on October 8. 2013 [date], and that this resolution has not been amended or revoked and is still in full force and effect. I further certify that the following persons, whose signatures appear after their respective names, now hold the positions referred to in the above resolution: Office or Position Name -.1~~atur~ Supervisor Scott Russell Date: 10 / 21 / 13 ~ ~ of .p of Town Clerk (7/~ (Signature) (Title) NMAC 3013 8/07 RESOLUTION 2013-740 s ~'m~.~ ADOPTED DOC ID: 9141 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-740 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 8, 2013: RESOVED that the Town Board of the Town of Southold hereby amends Resolution No, 2013-380 as follows: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute a Motor Vehicle lease agreement with Nissan Motor Acceptance Corporation in connection with athree-year lease for one Nissan Leaf for the Human Resource Center in an amount not to exceed ~k-~AOA $12,000, which shall be a legal chazge to A.6772.4.400.800 over the lease term, subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER: William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell ? WewOL? Used ? DemoEO salvage RETAIL CERTIFICATE OFvSALE IIII~IIIIIIIIIIIIIIIIIIIIIIIIIIIII (VIII IIIIIII III VEHICLE INFORMATION: No. 4 5 9 3 413 8 4 5 9 3 4 1 3 8 Year Make Mod ' - Body Type Color Weight (Unladen) Fuel Cylintlers Adult 7ype~ Seating 2013 NISSAN LEAF 4DSD GY 3256 E 0 Capacdy 5 Vehicle Identification Number Lien(s) Inspection Cenifirate Number Date of Inspection Inspection Station Number 1 N 4 P 9'D` C 4 1 8 1 6 L0 12670757 10 12 Z0 6 Plate/Permit Number Number M Dealer Plate Loaned Lease Sgyout Selling Price N A ?(Insp.NOtRequired) S LEASE DEALER INFORMATION (PnntNameandAddress) PURCHASER INFORMATION (Pont Name andAddress) Date of NISSAN-INFINITI LT;NILT INC,TRUSTEE Sale PO BOX 254648 SACRAMENTO CA 95865-4fi46 1C~ 21/2013 PRIOR OWNER INFORMATION (Print Name and Address Source of Ownership) Date of NISSAN OF GARDEN CTTY Purchase ODOMETER DISCLOSURE STATEMENT Federal and state laws require [ha[ you state the mileage of the vehicle described on this certificate, when transferring ownership. Failure ro do so, or not telling the truth about the mileage may result in fines and/or imprisonment. The odometer on the vehicle described above has: ~ 5 digits ®XCi digits, not including tenths ODOMETER READING l7~)a certify that, to the best of my knowledge, this odometer reading reflects the "ACTUAL MiLEACE" of the vehicle described above. ? 1 certify that, to [he best of my knowledge, this odometer reading "EXCEEDS MECHANICAL LIMITS" (no tenths) ? I certify that, to the best of my knowledge, this odometer reading is "NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY." DEALER CERTIFICATION: I certify: The vehicle described above was sold to the purchaur on the date indicated. At Ne time of delivery the purchaxr was entitled to register the vehicle. This vehicle complied with equipment requirements of the Commissioner's Regulafions. At the time of delivery, such equipment was in coodifion aM repair to render satisfactory and adequate service on the public highway under normal ux. Equipment certification does not apply to a vehicle sold as new, wholesale, ar salvage. All New Yd¢k State andlra;el roxeS due as a result of this. sale have bcen collected from the purchaxr. Falx made i b IassA trd meanor ant t ati 21 .45 1 w... DEALER(aattthoNAd repnsentatlve)•(SIGNlull name) pRINT full rtame of dealer M.autigriied rep: Date Dealer 10/21/2013 Nacttiliry PURCHASER - ( GN full name) PRINT full name of purchaser Date Selling Dealer 10 21/2013 N~sNOales _~.._._w e.o...o_._.__.a.,a_..._d.~_~._~.,.~..I~SSS~IAI-.7.N~..Tt:I.I.73._.1_T~N.Il„T S~EE_.~e•_._...._._..~W,1.7.2PtHf14Z.9....~_ ANY CHANGE OR ALTERATION VOIDS THIS CERTIFICATE MV-5010&06) ; I~.. _~I, 41~ ~ cyR-~ y 4 f -'~f5o• ~ ~i r., c p a r.' ~ iv "d : ' ~~4 ' \~.I~ sw•w ~wwmaxm~aem ewv.. uw ii 7 - IdE1N1YORK STATE ~ www.nysdmvcom y,' ~ 3 I~~ Year Make Model Code Body/1-lull ; Dacutnetit No. ,ir, " '23 2010 NISSA ALT 14DSD 764316R Fuel Cyl./Prop. New or Used Typ& of Tide [?Hte 1,$&u GAS 4 NEW VII~S~E ~ (s) ODOMETER READING. .00010 ~G , f 95865 ~ ~ s~ . i ~ ~ o-~t `AC@ ~ »F mAA p _ ' ~ .@, vYCf ~ Q ~ document is your proof of ownership for fhfs vehicle, tlgpt rn ure ' ' ~ safe place, not widh your licQase or registration or i"` . "e ~ po *~`$iur vehicle, boat or rhanufactured home complete the r ti4R on Fhls tjtle to the new owner- r ~ rn.~°~ holder Lienholder'-`"~~` 4 4~ i . t,~ +r~r > m,-. _ _ ~ m~', _ ienholder - Lienholder ,f ~ I `i ~i `4i MV-989 {4-08 - m..: t • • • " O O V c ~ z NISSAN-INFINITI LT 8900 Freeport Parkway Irving, Texas 75063-2438 Mailing Address: P.O. Box 660360 ~ Dallas, Texas 75266-0360 Telephone: 800.456.6622 RESTRICTED POWER OF ATTORNEY (For Vehicle Titling and Registration Purposes Only) KNOWN ALL MEN BY THESE PRES~~.11ySy~g~i~~NILT") hereby consasuit's atomey Ins fact for the sole purpose of executing on behalf of NILT, any and all documents pertaining to applications for original certificate of title, registrations, licenses and transfers of license plates, pretaining to the following described motor vehicle sold by said dealer to NILT: YEAR /MAKE: o?OI3 I~(i `~j,7q,Y1 MODEL: ~QQF~ r~~ c, SERIAL ~t~f`I A~OC_Pq tJ~~I~g~(nJ The powers and authority granter hereunder shall, unless sooner terminated or revoked, cease five years from the date of execution as set forth below. ANY SUCH APPLICATION MUST BE MADE IN THE NAME AND BEHALF OF NILT AND MUST INDICATE TITLE TO THE MOTOR VEHICLE AND OWNERSHIP OF SAID VEHICLE IN NISSAN-INFINITI LT; N ILT, Inc.,Trustee. A true and correct copy of this form shall be an acceptable substitute for the orginial which is on file with the dealer named in such application. IN WITNESS WHERE, NILT corporation has caused this instrument to be executed on its behalf by its Manager on this 9th day of February, 2012. Nissan-Infiniti LT ~~~~j~ (Sig ture) By: Judy Holloway (Print Name) State of Texas ) SS County of Dallas ) Subscribed and sw before me in and for the State of Texas, County of Dallas, this 9th day of February, 2012. , ,o... DIANE LDPEZ _ ~ Notary PubYc, Stete Gf Texas r~ ,7 Exliir¢s Notary Public ~~,.t;a~~`'r Jan~ory 14, 2014 FED ID # 33-622-6449 For leases owned by Nissan-Infiniti LT, Nissan Motor Acceptance Corporation acts as servicer. CSDLRNY 05/16/2008 CCS To: Nissan Motor Acceptance Corporation ("NMAC") Re: TOWN OF SOUTHOLD ("Customer") OPINION OF COUNSEL With respect to that certain retail installment contract, lease or similar agreement ("Agreement") dated October 21, 2013 to be executed by Customer and assigned to NMAC, I am of the opinion that: (I) the execution, delivery and performance by Customer of the Agreement have been duly authorized by all necessary action on the part of Customer; (II) the Agreement constitutes a legal, valid and binding obligation of Customer enforceable in accordance with its terms and all statements contained in the Agreement and all related instruments are true; (III) there are no suits, proceedings or investigations pending or, to my knowledge, threatened against or affecting Customer, at a law or in equity, or before or by any governmental or administrative agency or instrumentality which, if adversely determined, would have a material adverse effect on the transaction contemplated in the Agreement or the ability of Customer to perform its obligations under the Agreement and Customer is not in default under any material obligation for the payment of borrowed money, for the deferred purchase price of property or for the payment of any rent under any lease agreement which either individually or in the aggregate would have the same such effect; and (IV) all required public bidding procedures regarding the award of the Agreement have been followed by Customer and no governmental orders, permissions, consents, approvals or authorizations are required to be obtained and no registrations or declarations are required to be filed in connection with the execution and delivery of the Agreement. Coun or omer: gy: Date: I J(7~ In connectio_r, ivitlt ~nur transaction, Rit'ERHE.4IJ :~UTp nI.~LL may acquire information about r~ou as described in this notice, which we dandle as stated in this notice. This does not apply to information obtained in a non- financial transaction. 1 We collect non public personal information about yoirfroin the following sources: o Information we receive from you on application or other forms in connections with financial transaction; o Information about your transaction with us, our affiliates, er others; and o Information we rec&ive from a consumer reportirtg agency. 2. 6Ve may disclose all of the information we collect, as described above, to companies thatperfoim marketing services or other functions on our behalfor to other financial institutions with whom we have joint marketing agreeruents. We may make such disclosures about you as a consumer, customer, or former customer. 3. We may also dr'sclosa non public personal information about you as a consumer, customer, or former customer to non-affiliated third parties as permitted by law. d. We restricf access .to non public.personal information about you to those employees who need to know that information to provide products or services fo you. We maintain physical, electronic, and procedural safeguards that comply with the federal reg-iilations to guard youi non public personal information. ~.~.Grctl~^y Custo erSignaLure 18x0 Gld Ccunf ~ RIVER,yE ryRoad-Rcute58 Sales (631 A~' NE'W YORK 119rt 369-0600 • Fax (631J 369-2597 ~ ~ ~ ~ ~ ~ ~ rt.~ ~ l ~ ~ ~ ~ You havejustpurchyrsed a. Lttt, ,Al this fi' carfronrRiverhedd,4uto Ma11, registraego me' You hdv~ begin ~ivr~t a ~l3' daY ~em,~vorary. Yau should re~ei7ie.Yatrt' orlglnal registratlan an t}vo to three weefcy; I.lr~ot, pl~•~;Ye a ca!!. - TIIE,gMOU.NTI~IC~T.ts~D per O-R.LL.4SRgG,~F~.&'. T.~7'S,~StL.B'S'CONT.RACT ?'ITLEF.BFsSIS,4N.&ST -e~U1,~RZ&'Gld'T,R~4~DNr1ND M.4Y.FiYCRIs'D T 'r~Y1`9T-&; :IN~.SOM',~'IN,~'.T.f1NC.Zi'.S, IT COtYIM-rSS~70N8R OFD ~ F•i~.BSDUE ~ .,7.SR FILL ACTTp~TIC,4LLY' I'EIIICI&S: TX.&'D.h'..~LL.ER SECtT,fp,INGSUC$R,gD~,Z, ' N'ITHIN6QD~4YS O.F' ~4Ny R,4T-FON,~Y-p T.C,[,1~„RR~'ZlNA re rn some cases; the erti„i~e thaf ~y, calc'ulated,ts lower tkan the Rctua! Burration. fee which is due to ,Riverhe -will be due before ry,e can rel d.AutaMall, Ltd 1Xre difference your regzrYratlon. Customer's signature D«re.. /0%/3 MUNICIPAL CERTIFICATE 1, the undersigned duly appointed C~2fC of rowN of souTtioto do hereby certify as follows: I . Lessee did, at a meeting of the governing body of Lessee held in accordance with all requirements of law, approve and authorize the execution and delivery of a lease purchase agreement (the "Lease") between Lessee and NtssAN Moron accE~~"Lessor'") relating to the following: ~ Collateral Description: tots NtssnN tenF s Number of payments: s6 i; Frequency of payments: ~ i; Total amount of payments: $ Ir,z6r.7s 2. The following representative of Lessee was authorized to enter into the Lease and execute the Lease and all related documentation deemed necessary by the representative: Printed name: scoTT n RussE~t TItIe: TOWN SUPERVISOR Signature: 3. The above-named representative of Lessee held at the time of such authorization and holds at the present time the office designated above and the signature set forth opposite his or her name is the true and correct specimen of his or her genuine signature. IN WITNESS WHEREOF, 1 set my hand and the seal of the governing body of the Lessee. Printed Name of Secretary/Clerk: ~~/r3~'3e/r~J /-1, n/6~//ar9 Signature ofSecretary/Clerk: ~~,1~~_ ~ ~ . Date: (SEAL) Muni Resolution and hwnmbw~cy Signmurd_cvnc July 201} ADDENDUM TO MOTOR VEHICLE LEASE AGREEMENT (SignatureONE) This Addendum is dated as of 10/21/2013 is by and between NISSAN MOTOR ACCEPTANCE CORP ("Lessor') and ("Lessee") and amends that certain Motor Vehicle Lease Agreement of even date between Lessor and Lessee (the "Lease") as follows: h 1. Section Jb of the Lease is hereby deleted in its entirety and replaced with the following language: "Insurance. Lessee, will, at its expense, maintain at all times during the lease term, the following insurance (the "Required Insurance"): a) Comprehensive, including fire and theft insurance with a maximum deductible of $1,000; b) Collision insurance with a maximum deductible of $1,000; c) Property damage liability of $50,000 per occurrence; and d) Bodily injury liability of $100,000 per person and $300,000 per occurrence. Lessor shall be named as loss payee on the Comprehensive and Collision coverage, and as additional insured on all Liability coverage. In no event will the insurance limits be less than the amount of the applicable value of the Vehicle. Reasonable notice of alteration or cancellation should be provided to the Lessor in a timely manner. The proceeds of any such policies will be payable to Lessee and Lessor as their interest may appear. Upon acceptance of the Vehicle and upon each insurance renewal date, Lessee will deliver to Lessor a certificate evidencing such insurance. In the event of any loss, damage, injury or accident involving the Vehicle, Lessee will promptly provide Lessor with written notice thereof and make available to Lessor all information and documentation related thereto and shall permit Lessor to participate and cooperate with Lessee in making any claim for insurance in respect thereof. Lessee appoints Lessor as your attorney- in-fact [o arrange for and procure payment of insurance loss proceeds directly with Lessee's insurance carrier(s) and to endorse, present and collect insurance loss proceeds checks. NO PHYSICAL DAMAGE OR LIABILITY INSURANCE COVERAGE FOR BODILY INJURY OR PROPERTY DAMAGE CAUSED TO OTHERS IS INCLUDED IN THIS LEASE." 1~ 2. Section,~r7 of the Lease is hereby deleted in its entirety and replaced with the following language: "Indemnity. To the extent permitted by law and only from legally available funds, you agree to indemnify us from, and to pay on our behalf, any claim, loss or liability (including damages, costs, expenses and legal fees) which arises from or is related to the use, maintenance or operation of the Vehicle. This Section will survive termination of this Lease and/or repossession of the Vehicle. Any insurance we provide is secondary to the Required Insurance." 3. The following language is added as Sections of the Lease: "Non-Appropriation Of Funds. Lessee currently intends to continue the lease term through its maturity date and to pay all lease payments hereunder. Lessee further currently intends to do all things lawfully within its power to obtain and maintain funds from which the lease payments may be made, including making provision for such payments to the extent necessary in each annual budget submitted and adopted in accordance with applicable provisions of state law, to have such portion of the budget approved and to exhaust all available reviews and appeals in the event such portion of the budget is not approved. Notwithstanding the foregoing, the decision whether or not to budget or appropriate funds is reserved to lessee's governing body. if the Lessee shall not budget and appropriate sufficient funds for payment of lease payments required hereunder, then the Lessee may terminate this Lease on the next ensuing lease payment date and the Lessee shall not thereafter be obligated to pay lease payments or other payments required by this Lease. Lessee will immediately notiry Lessor or its assignee in writing of such termination and this Lease shall terminate on the last day of the fiscal period for which appropriations have been received or made without penalty or expense to Lessen, except as to (i) the portions of lease payments herein agreed upon for which funds shall have been appropriated and budgeted or are otherwise available and (ii) Lessee's other obligations and liabilities under this Lease relating to, or accruing or arising prior to, such termination. Upon such termination, Lessee agrees to peaceably surrender possession of the Vehicle to Lessor or its assignee on the date of such termination in the manner set forth in Section 11 hereof and Lessor will have all legal and equitable rights and remedies to take possession of the Vehicle. Upon such termination, Lessee shall not be responsible for the payment of any additional lease payments relating thereto coming due in succeeding fiscal periods. Notwithstanding anything contained herein to the contrary, all amounts owing under this Lease shall be payable only from legally available funds." 3`~ 4. The following language is added as Section~Y of the Lease: "Representations, Covenants And Warranties. Lessee hereby represents, covenants and warrants to Lessor as of the date hereof and al all times during the lease term that (i) Lcsse~e has full power and authority under the constitution and laws of the state in which it is located to enter into this Lease and the Muni Addendum-SignatureONE-Multistate July 2013 Page 1 of 2 transactions contemplated hereby, and to perform all of its obligations hereunder; (ii) each officer of Lessee executing this Lease has been duly authorized to execute and deliver this Lease by proper action and approval of its governing body at a meeting duly called, regularly convened and attended by a requisite majority of the members thereof, or by other appropriate official approval; (iii) the execution, delivery and performance of this Lease and all documents executed in connection herewith (this Lease together with all such documents shall be collectively referred to herein as the "Lease Documents") have been duly authorized by all persons, governmental bodies and agencies necessary to authorize and approve this Lease; (iv) the Lease Documents constitute legal, valid and binding obligations of Lessee, enforceable against Lessee in accordance with their respective terms; (v) the execution, delivery and performance of this Lease by Lessee shall not (a) violate any federal, state or local law or ordinance, or any judgment, order, writ, injunction, decree, rule or regulation of any court or other governmental agency or body applicable to Lessee; or (b) conflict with or result in the breach or violation of any term of, or constitute a default under, or result in the creation of any encumbrance on any assets of the Lessee or the Vehicle pursuant to any obligation to which Lessee is a party or by which it or its assets may be bound, except as herein provided; (vi) in authorizing and executing this Lease, Lessee has complied with all open meeting laws, public bidding requirements and other laws applicable to this Lease and the acquisition by Lessee of the Vehicle; (vii) Lessee has, in accordance with the requirements of law, fully budgeted and appropriated sufficient funds for the current fiscal year of the Lessee to make the lease payments scheduled to come due during such fiscal year, and such funds have not been expended for other purposes; (vii) the Vehicle is essential to the function of the Lessee or to the service Lessee provides to its citizens and the Lessee has an immediate need for, and expects to make immediate use of, substantially all of the Vehicle, which need is not temporary or expected to diminish in the foreseeable future; (ix) no lease, rental agreement or contract for purchase to which Lessee has been a party at any time during the last five years, has been terminated by Lessee as a result of insufficient funds being appropriated in any fiscal year; (x) [he Vehicle will be used by Lessee only far the purpose of performing one or more of Lessee's governmental or proprietary functions consistent with the permissible scope of Lessee's authority; (xi) there is no action, suit, proceeding, inquiry or investigation, at law or in equity, before or by any court, public board or body, pending or threatened against or affecting the Lessee, nor to the best knowledge of the Lessee is there any basis therefor, wherein an unfavorable decision, ruling or finding would materially adversely affect the transactions contemplated by this Lease or any other document, agreement or certificate which is used or contemplated for use in the consummation of the transactions contemplated by this Lease; and (xii) no event or condition [hat constitutes, or with the giving of notice or the lapse of time or both would constitute, an event of default, exists at the lease commencement." Lessor: Lessee: TOW SOUTHOLD sy: sy: Name: Name: s TT A RUSSELL Title: Title: TOWN SUPERVISOR Muni Addendum-SignatureONE-Multistate July 2013 Page 2 of 2 ~~fST@hfER CHEC'KLTST FQRtvF DATE: io%I /l3 VEWTCLE YEAR: 0?0%~ nyA{(E; ,(Ji554nt MODEL: ,(,eaF PURCHASE PRICE: $ ,3//~10~ ~ TERMS O EAS OR FINANCE: 31O MONTHS p $ _ PER MDNTH INTEREST RATE; ~~PERCENT NAME.OF LENDER: nl1~T Customer acknowledges by the sigr~,ature below that the terms of the purchase and finance of the automobile 'as set- forth above are accurate; that the Customer understands sarn2, and also corrflrms receipt of -the following fully executed and completely frlled In documents at the time of the delivery of the automobile: !~~afcs order r~//~etail Installment contract _?li ited or new warranty contract including terms and conditions ~stomer receipt vehicle registration title application fail certitrcate of sale mortification of emissions compliarice _~nfirmation of accidental physical damage insurance _~insurance ID cards _ customer edge contract _ customer declaration, odometer and damage disclosure statement credit application _ 1;redit authorization .-/other: E ~ _ other. other, 'signature of customer: ?~4Q _ signature of Company repre entative: NISSAN NOTOR Account # INCENTIVE CLAIM FORM ? COLLEGE GRAD p CUSTOMER CASH ? OWNER LOYALTY p OTHER: PROGRAM ID BUYER'S FIRST NAME BUYER'S MIDDLE INITIAL I~IYI~Sl~PM4L D BUYER'S STREET ADDRESS NE NUMBER 53 J5 RTE 25 ~,'€~j~4,~~ BUYER'S CITY SO THOLD NBUYER'S STA"fE 181UYER'S ZIP CODE PREVIOUS VEHICLE INFORMATION PREVIOUS MODEL CODE: PREVIOUS ACCOUNT NUMBER: VEHICLE IDENTIFICATION NUMBER NEW VEHICLE INFORMATION MODEL CODE: CHECK ONE: DELIVERY DATE: VEHICLE IDENTIFICATION NUMBER PURCHA::E 1N AZ0CP9DC418165 17013 ? LEASE 10/21/2013 DEALERSHIP VALIDATION 1 certify that the vehice itlent~ed above IS eligible for a NISSAN incentive awani in accordance with the subject inasMive progmm Official Progra~ Rules. pr~pp~~ AUTHORIZED DEALER SIGNATURE 1-OTCl /2013 PRINT NAME P,ND TITLE RI ~HAR1~FlALL LTD DEALER CODE (~I.~B6HIPO~~IE NUMBER AWARD INFORMATION (Note:Dealer is responsible for payment to the customer on cash programs. Nissan North America, Inc. will reimburse PAYABLE TO (CHECK ONE) ? DEALER D CUSTOMER ? OTHER: PAYABLE TO (PRINT NAME (S)) SOCIAL SECURITY NUMBER OR FEDERAL STREET ADDRESS, CITY, STATE, AND 7JPCODE CUSTOMER MUST READ AND COMPLETE THIS SEC710N: Do not sign this claim forth unless rt is completely filled in. Please read this form thoroughybefore signing and retain a copy of this daim form. Any inquiry regarding award payment must reference the program id shown above. IF "CUSTOMER CASH BACK" IS ELECTED, THEN PLEASE CHECK ONE: ? Issue the cash payment directly to me from the dealer. ? I hereby assign the cash payment to the dealer • If I elect to assign the cash payment toward the purchase or lease of a new vehicle, and assign payment to the dealer, I hereby release Nissan NoAh America, Inc. from any further claim or obligation concemirrg the "Customer Cash Back" on this vehice. • I acknowledge that the cash award is offered by, and will be funded by, Nissan North America, Inc., the manufacturer or distributor of the vehide, either directly or by payment to the dealer (in the case of a college program). • If I have been offered the choice of a spedal finance rate incentive in the akemative to the cesh award, I hereby waive that finance rate incentive and adcnowiektge that any rate that I pay in finantlng the purchase of the vehicle is the interest rate 1 have negotiated and does not represent a portion of the price of the vehice. IF A SPECIAL FINANCE RATE IS ELECTED IN ADDITION TO, OR IN LIEU OF "CUSTOMER CASH BACK;' THEN PLEASE CHECK THIS BOX: ? Apply Special Finance Rate I accept a specal finance rate incentive. I acknowledge that the: cost of the incentive is to be funded by Nissan North America, Inc., and hereby release Nissan North America, Inc. from any further daim or obligation concerning the Special Finance Rate on this vehicle. If 1 have keen offeretl the choice ct a cash award incentive in the alternative to the spedal finance rate incentive, 1 hereby waive the cash award and acknowledge that any price I spay for the purchase of the vehicle is the price I have negotiated and does not represent a portion of the finance charge for the finantlng of the vehicle. I acknowledge that Nissan Nort erica, Inc. is not a finance company, creddor under any retail installment contract, or selle~ ff ret it installm t c acLS a is of a provider of any finantlng on the vehicle. CUS OMER SIGNATURE ~ ~ ' ' DATE Dealer Name: Riverhead Auto Mall Dealer Phone#:631-369-0600 C)@al0((I8C{K i !i? e5 Dealer Fax 631-369-0342 PLEASE PRINT -INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. INSTRUCTIONS: (3) ~ If you arc applying forjoint credit with another person, complete sections A and B. You may apply for credit inyour name alone, whether or no! you arc married. We intend to apply forjoint credit. (1) Please indicate whether you are applying for ~ Individual Credit ? Joint Cretlit ? Community Property State O Business Application App (cant p t toanl' t (2) ? If you are applying for individual credit inyour name and relying on your own income or assets and rte the income or assets of another person as the basis (or repayment of ~ If you are married and live in a community property state, please complete Section A about the credit requested, complete only Section A. yourself and Section B about your spouse. You must sign this application. Your spouse must sign this application only if sme wishes to be a Co-Applicant. F _S. i Legal Business Name Tax ID Busness Phone' TOWN OF SOUTHHOLD 11-6001939 (631) 765-1800 Address Apt # I Suite # P.O. Box Rural Route Ciry State Zip 53095 ROUTE 25 SOUTHOLD N'Y 11971 Date Business ESlaDlished (MM/DD/YYYY) State of Incorporation # of Employees Veers in Business Mosl Recent Financial Statement 01-20-1640 5+ CPA-Audited Bank Name Checking Account # Contact Name al Bank Contact Phone # CAPITAL ONE 6454555555555 TAMMY LEISEN (631) 531-2324 Atltlilional Comments THIS IS A ONE PAY LEASE ..................THANKS JOHN Last Name First Name Midtlle Initial Social Security Number Birth Date Adtlress Apt # /Suite # P.O. Box Rural Route City Slate Zip Home Phone' Cell Phone' Residential Status How Long ? Homeowner ? Rent ? Family ? Other _Vrs. _MOS. RenUMtg. Pmt. $ E-Mail Address Driver's License No. Driver's License State Time at Previous Adtlress _Yrs. _Mos. Previous Full Address (if less than 2 years) Apt # /Suite # PD. Box Rural Route Ciry State Zip Employer Name Employment Type ? Employetl ? Unemployed ? Self-employed ? Military ? Retired Stutlent ? Other Salary Salary Type Occupation Length o(Employment Work Phone Number' ? Weekly ? Bi-Weekly ? Monthly ? Annually Yrs. Mos. Previous Employer Name Previous Employment Type ? Employed ? Unemployed ? Self-employetl ? Military ? Retired Stutlent ? Other Previous Occupation Length of Employment Previous Work Phone Number _Yrs. _Mos. Alimony, cDild suppaL or separate maintenance income neetl nor be revealed it you tlo rat choose ro have it consitleretl as a basis Im repaying This obligation. Other Inwme (Monthly) Source of Other Income Comments THIS IS A ONE PAY LEASE ..................THANKSDOHN I hereby consent to receive autodialed and/or pre-recorded telemarketing calls from or on behalf of dealer (or any financing source to which dealer assigns my contract) at the telephone number(s) provided in this credit application, including any cell phone numbers. I understand that this consent is not a condition of purchase or credit. Paget of3 pT110113 Printetl on 1 010 92 01 3 at N:43 AM dealertrack ~ ,i~,ra Fnhya~~~;" Ir-~e,~N~v DEALER SECTION' Dealer # Vehicle Type Mileage Product Ty De Stock Number Source 114181 New PO Lease cemred Pre owned ? Year Make Model Trim VIN 2013 NISSAN LEAF 4DR HB S Term Cash Selling Price Sales Tax T & L Cash Down Front-End Fees Rebate Net Trade Acq Fee Unpaid Balance 36 32999.00 10,000.00 8,150.00 595.00 15,444.00 AccitlenVHealth Ins. Credit Life Insurance Gap Service Plan Back-Entl Fees Est. Amt. Financed 15,444.00 MSRP InveiceNVholesale Value t"fholesale Source Retail Value Retail Source Estimated Payment Requested APR 31,120.00 29,432.00 529.00 Bookout Date Lender Program Vehicle Bookoul ~ Vehicle Options TRADE IN Information Year Make Motlel Trim Uenholder Monthly Payment AGREEMENT You understand and agree that you are applying for credit by providing the information to complete and submit this credit application. We may keep this application and any other application submitted to us and information about you whether or not the application is approved. You certify Ihat the information on the application and in any other application submitted to us, is true and complete. You understand that false statements may subject you to criminal penalties. The words "you," "your" and "yours" mean each person submitting this application. The words "we," "us." "our" and "ours" as used below refer to us, the dealer, and to the financial institution(s) selected to receive your application. You authorize us to submit this application and any other application submitted in connection with the proposed transaction to the financial institutions disclosed to you by us the dealers. This application will be reviewed by such financial institutions on behalf of themselves and us the dealer. In addition, in accordance with the Fair Credit Reporting Act, you authorize that such financial institutions may submit your applications to other financial institutions for the purpose of fulfilling your request to apply for credit. You agree that we may obtain a consumer credit report periodically from one or more consumer reporting agencies (credit bureaus) in connection with the proposed transaction and any update, renewal, refinancing, modification or extension of that transaction. You also agree that we or any affiliate of ours may obtain one or more consumer credit reports on you at any time whatsoever. If you ask, you will be told whether a credit report was requested, and if so, the name and address of any credit bureau from which we or our affliate obtained your credit report. You agree that we may verify your employment, pay, assets and debts, and that anyone receiving a copy of this is authorized to provide us with such information. You further authorize us to gather whatever credit and employment history we consider necessary and appropriate in evaluating this application and any other applications submitted in connection with the proposed transaction. You understand that we will rely on the information in this credit application in making our decision. We may mondor and recrlyd telephone calls - regarding your account for quality assurance, compliance, training, or similar purposes. Page2M3 OT110I13 Prinle0 on 1 010 9 2 01 3 at 1t93 AM dealerlrack ,,~e-s FEDERAL NOTICES IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT If applicable to your credit transaction, to help the government fight the funding of terrorism and money laundering activities, Federal law requires financial institutions to obtain, verify, and record information that ident~es each person who opens an account. What this means for you: When you open an account, you will be asked for your name, address, date of birth, and other information to identify you. You may also be asked to see your driver's license or other identifying documents. STATE NOTICES California Residents: An applicant, if married, may apply for a separate account. Maine and Tennessee Residents: You must have physical damage insurance covering loss or damage to the vehicle for the term of the contract. For a lease, you must also have the liability insurance as described in the lease. You may purchase required insurance through any insurance agent or broker and from any insurance company that is reasonably acceptable to us. You are not required to deal with any of our affiliates when choosing an agent, broker or insurer. Your choice of a particular insurance agent, broker or insurer will not affect our credit decision, so long as the insurance provides adequate coverage with an insurer who meets our reasonable requirements. New Hampshire Residents: If you are applying for a balloon payment contract, you are entitled, if you ask, to receive a written estimate of the monthly payment amount for refnancing the balloon payment in accord with the creditor's existing refinance programs. You would be enttled to receive the estimate before you enter into a balloon payment contract. A balloon contract is an installment sales contract with a foal scheduled payment that is at least twice the amount of one of the earlier scheduled equal periodic installment payments. New York Residents: In connection with your application for credit, a consumer report may be obtained from a consumer reporting agency (credit bureau). If credit is eMended, the party or parties extending credit or holding such credit may order additional censumer reports in connection with any update, renewal or extension of the credit. If you ask, you will be told whether a consumer report was requested and, if so, the name and address of any censumer reporting agency (credit bureau) from which such credit report was obtained. Ohio Residents: Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers and that credR reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. Rhode Island Residents: Consumer reports may be requested in connection with this application. Buyer has the right of free choirxi in selecting an insurer to provide insurance required in connection with this transaction subject to our reasonable approval in accordance with applicable law. Vermont Residents: You authorize us and any financial institution with which this credit application is shared, and each of their respective employees or agents, to obtain and verify information about you (including one or more credit reports, information about your employment and banking and credit relationships) that they may deem necessary or appropriate in evaluating your credit application. If your credit application is approved and credit is granted, you also authorize the parties granting credit or holding your account, and their respective employees and agents, to obtain addtional credit reports and other information about you in connection with reviewing the account, increasing the available credit on the account (if applicable), taking collection on the account, or for any other legitimate purpose. Married Wisconsin Residents: No provision of any marital property agreement, any unilateral statement under Wis. Stat § 766.59 or any court decree under § 766.70 applied to marital property adversely affects our interest unless you furnish a copy of the agreement, statement, or court decree or we have actual knowledge of such adverse provision before credit is granted. If you are making this credit application individually and not jointly with your spouse, complete Section A about yourself and Section B about your non-applicant spouse. Your non-applicant spouse should not sign the credit application if you , are applying for individual credit. This application may ba submitlad to the folloxing (nancial insliNtions INama(s) and Atltlressies)I BY SIGNING BE , YOU CE~RTIFY~~TH~A~T~YOU HAVE READ AND AGREE TO THE TERMS AND DISCLOSURES ON THE PAGES OF THIS APPLICATION. ' A LICANTS SIGNATURE DAT CO-APPLICANT'S SIGNATURE DATE COPYRIGHT iC)2013 DEALERTRACK. INC ALL RIGHTS RESERVED Page 3013 DTt 10113 Printetl on 10/092013 a111:43 AM Security+Plus° Model Year 2014 and later PREPAID MAINTENANCE In return for your payment, NESNA', will arrange For a participating Nissan dealer to perform the service(s), including inspection and/or replacement of the parts listed and described in Exhibit A of this Agreement, as applicable to the type of Agreement that you purchased and vehicle which is covered by the Agreement. Please refer to Exhibit A for your applicable plan's specific coverage information. `Nissan Extended Services North America, GP, P.O. Box 685004, Franklin, TN 37068-5004, Tel. 615 725-1000. © ~ . This Agreement applies during the term shown in the Application/Declaration. Standard and Premium Agreements begin at the Manufacturer's New Vehicle Warranty start date (i.e., the "in-service date" described in your warranty booklet and listed in the Application/Declaration) and at zero miles on the odometer. Basic and Basic+Plus Agreements begin at the time the Agreement is sold. This Agreement continues until the expiration date or vehicle mileage listed in the Application/Declaration is reached, or until the performance of the final scheduled maintenance service covered (listed in Exhibit A) by the term cif this Agreement as provided in the Application/Declaration, whichever is earlier. "Odometer Reading," which appears in the Application/Declaration, means the actual number of miles which :he vehicle has been operated since manufacture as indicated on the vehicle's odometer, unless the odometer is/has been broken, has been replaced or has been tampered with. In such a situation, NESNA will make a good faith calculation of the total actual number of miles of vehicle operation since manufacture based on the information available. If ever the odometer is tampered with, and/ or is inoperative, so that the vehicle's total actual number of recorded miles of operation since manufacture cannot be accurately determined by NESNA, this Agreement will be void. Odometer reading reflects the mileage based upon the recording device and numerous factors, and may not reflect the actual distance traveled. © TICS ~CURrrY+ D Mk NT GQYHRS " `Refer to Exhibit A for coverage afforded by this Agreement for the type of vehicle (model/trim) and plan purchased, up to the time/mileage term limit (whichever occurs first) listed in the Application/Declaration. tlIN~EN TM6S~ SEttVtCf~ l1AA?Y B6 The routine maintenance services described in Exhibit A of this Agreement should be performed at the time and mileage intervals specified in Exhibit A. ©SCH 6D Mf~NANCE Aiti~ Please refer to the Maintenance Service Schedule described in Exhibit A for specific items and intervals. ThE~ Optional Premium Maintenance Upgrade items listed in the back of the Nissan Service and Maintenance Guide, and any other additional maintenance items NOT covered under this plan, may need to be inspected and/or replaced. For details relating to the expiration of your Agreement, refer to the Application/Declaration. For the Premium, Standard, Basic+Plus and Basic Plans, the routine maintenance services should be performed every 6 months or 5,000-mile interval. For Nissan GT-R, routine maintenance services should be performed every 6 months or 6,000 miles, whichever occurs first. For Nissan LEAF, routine maintenance services should be performed every 6 months or 7,500 miles, whichever occurs first. PART~IK~.Uip C~A811T The Basic Basic+Plus Standard and Premium Plans cover replacement of engine oil and oil filter. The Premium and Standard Plans also cover replacement of brake fluid, in-cabin microfilter and engine air filter. Replacement of covered parts/fluids will be made with Genuine Nissan or Nissan-approved replacement parts. Please refer to Exhibit A for parts/fluids covered. This plan ~s for oil chances using regular (conventional petroleum-based) engine oil (except for the Nissan GT-R and the Altima Hybrid that specify and for which this plan covers the cost of special engine oil) Your Nissan dealership may offer you semi-synthetic or full synthetic oil, or Genuine Nissan ester oil, neither of which is covered by this service agreement, but is available for the additional cost of the alternative oil at the time of each oil change. NES-PPM-525 0413 1 CUS70MER HOW TO RECEIVE SERVICES • Return the vehicle to the selling Nissan dealer or the nearest participating Nissan dealer. • Keep this Agreement available in your vehicle. These services must be performed by your selling Nissan dealer or by any participating Nissan dealer in the U.S. (including Alaska and Hawaii, but excluding U.S. Territories). Should you require assistance in locating the nearest participating Nissan dealer, call Nissan Consumer Affairs at 1-800-NISSAN-1. Services pertormed at any other service facility are not covered under the terms of this Agreement and will NOT be eligible for reimbursement. .CAR RENTAL REIMBURSEMENT (not applicable to GT-R•) The Premium and Standard plans provide reimbursement for the actual expenses of substitute transportation up to $35, limited to one day, when having your scheduled maintenance performed as shown in Exhibit A. The LEAF plan provides reimbursement for the actual expenses of substitute transportation up to $35, limited to one day, when having your scheduled maintenance performed at the 30,000-mile service. The term of your Agreement, which is detailed in the Application/Declaration, will determine your eligibility for car rental reimbursement. Standard Agreements for a term of one year do not provide for car rental reimbursement. `Service Loan Cars are provided under the GT-R's ownership amenities during the Powertrain Warranty. NO DEDUCTIBLE Coverage for parts and services (including taxes) for maintenance services eligible under this Agreement includes no deductible. m WHA71S NOT COVERED NV200 Taxi is not eligible for coverage. Any items not listed in Exhibit A for your type of plan and vehicle are not covered. Maintenance otherwise covered by this Agreement which is required due to incidents caused by operating the vehicle in severe usage conditions such as pulling a trailer or other vehicle that exceeds Nissan's recommendation or exceeding the maximum Gross Vehicle Weight (GVW) of the vehicle is not covered by this Agreement. (See your owner's manual.) This Agreement does not cover incidental or consequential damages including but not limited to: loss of the use of the vehicle, rental vehicle, storage charges, lost wages, inconvenience, and commercial loss. m~ ROAD HAZARD PROTECTION` This Agreement provides Tire Road Hazard Protection as detailed below. (Tire road hazard protection is not available on the Basic plan and all plans purchased from Florida dealerships.) • Tires This Agreement provides protection against damage to tire(s) that is not covered by the fire manufacturer's warranty and is caused by roadway debris such as potholes, nails, glass, or any other materials that might cause damage to the tire(s). • Eligibility and Extent of Coverage This Agreement covers the four original tires equipped on the vehicle at the time of your purchase of the vehicle. This Agreement provides reimbursement for your fire repair costs or replacement of a covered tire(s) for the term of the plan or a maximum of 36 months on the 48- and 60-month plans, whichever is less, or until the covered tire's tread depth wears below 2/32 inch (4/32 inch for truck/sport utility vehicles), whichever occurs first (time or mileage). • Flat Tire Repair Coverage (not applicable to GT-R") This Agreement will cover 100 percent of the cost to safely repair a covered fire up to a maximum of $35 in the event that a fire develops a repairable leak or puncture due to a road hazard condition. **GT-R tires must be replaced, once removed from the wheel. • Tire Replacement Coverage This Agreement covers the cost of a required fire replacement of a covered fire if replacement becomes necessary due to damage caused by anon-repairable road hazard in accordance with the pro-rated schedule listed below. Eligible tires are covered up to $250 per claim, ($550 per fire for GT-R) up to a maximum of four damaged tires per vehicle during the period of fire coverage provided by this Agreement (see above). Included in this amount is a $25 allowance (per tire) for mounting & balancing, replacement of rubber valve stems, wheel weights, and fire disposal fees. • What Is Not Covered Premature or irregular fire wear; fire damage due to improper inflation, misalignment of wheels, fire, a vehicle collision or accident, vandalism, malicious or intentional acts or abuse, fire chains, or mechanical defects of the vehicle; scuffing damage to sidewalls or other cosmetic damage; roadside assistance services and towing costs. NOTE: This is a fire repair/replacement reimbursement program ONLY. As detailed above, roadside assistance and towing are not covered or included. Tire Tread Depth Remaining Replacement Coverage Percent Tirc Trcad Deplh Remaining Replacement Coverage Percent Cars 8/32" or Greater 100% Light Truck and 10/32" or Greater 100% 6/32" to 7/32" 75% Sport Utility 8/32" to 9/32" 75Mo 4/32" to 5/32" 50% 6/32" to 7/32" 50% 2/32" to 3/32" 25% 4/32" to 5/32" 25Mo 2/32" or Below 0% 4/32" or Below 0% NES-PPM-525 0413 2 • How To Receive Reimbursement For Tire Road Hazard Repair or Replacement Many Nissan or Infiniti dealers will be able to make necessary fire repairs or replacement services, and process your claim for reimbursement. If you have the repair/replacement done at an independent repair facility, you must submit a letter requesting evaluation for reimbursement which must include the following five items: 1. Full VIN and Agreement number 2. Vehicle mileage 3. Original repair order receipt from the dealership or repair facility 4. Tread depth of damaged fire and cost of repair /replacement 5. Reason for fire repair or replacement (what happened that caused the damage) Mail to: Security+Plus Prepaid Maintenance Tire Protection, Claims Department P.O. Box 9145, Medford, MF1 02155. • Recorded information about how to obtain reimbursement is also available by calling 1-800-225-2476, Option 3. • Tire road hazard protection is not available on Basic plans and all plans purchased from Florida dealerships. • If you also have a Security+Plus Gold Preferred, Silver Preferred or Powertrain Preferred Vehicle Protection Plan, you can use the Roadside Assistance benefits provided with that plan to obtain flat fire service (change to your working spare) and then have your fire repaired or replaced under your Tire Road Hazard protection included with Security+Plus Prepaid Maintenance. 'Tire Road Hazard Protection services are administered by Cross Country Motor Club, Inc. Medford, MA 02155, except in AK, CA, HI, OR, WI, and WY, where services are provided through Cross Country Motor Club of California, Inc., iVledford, MA 02155. Reimbursement for claims may be mailed directly to: Security+Plus Prepaid Maintenance Tire Protection, Claims Department, P.O. Box 9145, Medford, MA 02155. (Tire road hazard protection is not available on the Basic plan and all plans purchased from Florida dealerships.) A MtAf~RI~M'f'Y THIS AGREEMENT IS NOT A WARRANTY, AN EXTENSION OF A NEW VEHICLE WARRANTY, OR AN IMPLIED OR GENERAL WARRANTY, AND IT IS NOT PROVIDED OR SOLD AS A CONDITION OF, OR INCLUDED WITH, THE SALE OF THE VEHICLE. This Agreement is a "Service Contract" as defined in federal law and is sold only as a separate product apart from the vehicle itself. (See 15 USCS SEC. 2301 (8).) BY ENTERING INTO THIS AGREEMENT, YOU DO NOT WAIVE ANY APPLICABLE WARRANTIES. Be sure to read this Agreement carefully so that you understand the difference in coverage between your Warranties and this Agreement. FURTHER, you are advised that there are various state and federal laws that protect your interests as a consumer. In the event of a problem that cannot be resolved with NESNA, you may have other rights and remedies available to you. 1kDDiTlONSI~7Ct'. +iJ3~0lIS , The following state additions apply: Alabama, California and Washington: Cancel fee: $25. Florida: Cancel fee: $25. Transfer fee: $40. Georgia: No cancel fee. m ~'~~a You or a person authorized by you may cancel this Agreement by submitting a written cancellation request which includes the mileage (odometer reading) of the vehicle at the time the cancellation is to be effective, and mailing this information to your selling dealer as listed under the Application/Declaration. NESNA and/or the Lienholder may cancel this Agreement if: a) your vehicle is a total loss or repossessed, or b) your odometer has been stopped or changed during the term of this Agreement, or c) the registered vehicle has been used in any manner not covered by this Agreement. If this Agreement is cancelled within sixty (60) days from the Agreement effective date, then you will receive a full refund provided you have not filed a claim. If you have filed a claim or if this Agreement is cancelled after sixty (60) days, then the refund will be calculated based on the greater of the time in force or the mileage driven compared to the total time or mileage of your term. In addition, a processing fee of $50 will be deducted from the refund. NOTE: If this Agreement was financed, then the refund will be paid to the lienholder unless proof of lien payoff is submitted. ® f This Agreement is for the benefit of the Purchaser and applies only to the vehicle listed in this Agreement. Howc;ver, this Agreement may be transferred to subsequent owners of the covered vehicle under the following conditions: 1. The vehicle'sservicerecordsarecurrentandindicatethatthevehiclewasmaintainedinaccordancewithNissan'srecommendations. In the event service records are not available, NESNA may require the vehicle to be inspected and serviced at an approved repair facility at the owner's expense to ensure the vehicle has been properly maintained. If the inspection and service disclose abnormal vehicle conditions, the transfer request may be rejected. This determination shall be within the sole discretion of NESNA. 2. The transfer request is made within thirty (30) days of change ire ownership. 3. The transfer information and the appropriate signatures are provided in the Transfer Certificate section. 4. A transfer fee of $50 payable to Nissan Extended Services North America is included with the transfer request. Payment may be by check or money order. An updated VSC will be sent to the subsequent owner after NESNA's receipt and successful processing of all requested material. NES-PPM-525 0413 3 CUSTOMER F~2, r,_R1~FIE~`At~. a..u., Address: City: State: Zip: Phone: Date of Transfer: Odometer at Transfer: Transferred to: Address: City: State: Zip: I have read and understand all the terms and conditions listed above: Signature of Former Owner: Date: Signature of New Owner: Date: Your transfer request must include the following: • Current and new Agreement holder signatures • Transfer date and mileage • Current Agreement holder's signature on the transfer request form OR copy of Power of Attorney and signature of that person who is authorized to sign for the current Agreement holder • Change of Ownership documents (at least one of the following: copy of title, registration application, Bill of Sale, and odometer reading on that date) • Transfer fee, by personal check or money order, payable to 'Nissan Extended Services North America' or 'NESNA'. Refer to Section 15 for transfer fee information. Mail the items listed above, a copy of this Transfer Certificate and your transfer fee payment to: NESNA P.O. BOX 685004 (A-4-F) FRANKLIN, TN 37068-5004 NESNA may require the vehicle to be inspected and serviced at the owner's expense to assure that the vehicle has been properly maintained. If the inspection and/or service records show any abnormal conditions, NESNA will reject the transfer request. If you have any questions, please contact Nissan Consumer Affairs at 800-647-7261. NES-PPM-525 0413 q EXHIBIT A Year 1 Year 2 Year 3 Year 4 Miles 5,000 10,000 25,000 30,000 Months 6 12 30 36 w k... w'o Replace engine oil and filter Rotate tires (except Z) Replace brake fluid _ s Re lace engine air filter pe. Replace in-cabin microfilter' ~ a ~n Replace manual transmission oil (Frontier only) `iti.. g ti.. Rental Car if a 0 a ~'ymns °'a~m ~ ~wu"ssa n%maa'y`a a~¢a.4 ~ ~ ~ w.. ID °ay,` Automatic transmission/CVi fluid° ° Axle & suspension parts _ Brake lines & cables a _ %,a~. Brake pads, drums, rotors & linings a:- #kx.. Differential oil' _ mw i„ Drive shaft boots' _ Engine drive belts a s ~ y„%. Exhaust system ~ ,x _ ~ ao Front suspension ball joints sy.; Fuel lines/connections ro ~ Fuel tank vapor vent system hoses a,,; - Manual transmission oil' _ ~s¢.. Propeller shalt (4WD/AWD) _ ~,yg+. Steering gear and linkage _ Steering links a ball joints _ Transfer case oil (4WD/AWD) «q' a. :rv ~ Year 5 Year 6 Year 7 Year 8 Miles 45,000 50,000 w' -8E 65,000 70,OW : ~ M . Months 54 60 78 84 ' " " 'xpx...:e a%oysatxa. .#;.=am,+aa#~m Wg~ae%i, aa~a ,xb4aKs m xk.:aNkg .+s W Replace engine oil and filter nwm ~ m ww a. ~ ~ ,xe ~ Rotate tires (except Z) o-+xw a,n %yy rc:*~,.. _ e* ,u a; Replace brake fluid gp~ Replace engine air filter xxa aapasa ae. APaK nx:* Replace in-cabin microfilter' ~p# w ~ ~ Replace manual transmission oil (Frontier only) 'hw:' nR~a Rental Car ""a$arx44rta .N " ~ saa a+i~s, ase ay.x s.:a r Fe=4txaa xaa ssb§t d§ ~#.xi `~n~ia €x.x,.+. +s~ S 9kda: . I Automatic transmission/CVT fluid`' y6a£# $8#~. ax:4 ~ NA §.sb*•~ _ Axle & suspension parts ~ ~ $y # # ~g pg _ ~ _ xx Brake lines & cables a ~ $x aEa Brake pads, drums. rotors & linings f n = m% afiW Differential oil' +e a3"y«s x {I:,%~ _ k q, Driva shaft boots' r Engine drive belts #ax' #a*., ~g+.a _ Exhaust system , i rt A 8a.. _ _ - ' Fron[ suspension ball joints i _ _ Fuel lines/connections {T 0 Fuel tank vapor vent system hoses a t g axe ;%ay, ~ Manual transmission oil° .x8e%y g - _ _ 5 Propeller shaft (4WD/AWD) ¢ s9 _ Steering gear and linkage *naa ~ fr _ Steering linkage ball joints a ~ ~ ~ Transfer case oil (4WD/AWD) V s ,.exasa aaaa a,,. +is ~ gre ' StendeN equipment on cube, Murano, Ahima (except 2.5 Baaa), Altima Ceupe, Armada Platinum, Pathfinder, 'All front wheel drive, 4WD, AWO models. Frontier l.E and Pm~4X OH-Road, Maxima, titan HinA Cah lE, Ouest, Rogue, Sentra, Versa (except 1.fi Entry) and ^ cube, Murano, Altima, Altima Coupe, Maxima, Rogue, Santa, Versa Ntera (except N). Optional accessary on all other models. '2, Armada, Frontier, RaAUe AWO, Pahfinder, Titan, Xterre, Muane AWO °Replece (not just inspect) oil/fluid If towing a hailer, using scamper pr scar-top carrier, ar driving on rough or muddy roads NES-PPM-525 0413 6 _ - CUSTOMER EXHIBIT A Year 1 Year 2 Year 3 Year 4 Miles 5,000 10,000 15,000 20AOD : , 25,000 30,W0 ...36,008 40,000 Months 6 12 a5 .'".-24 30 3fi 47 IB Covered services a[sd rapie4xments - - . - Replace engine ail and filter w Rotate tires (except Z) Replace brake Ouid Replace engine air filter Replace Incabin mlcrofilter' Replace manual Iransmss'on o I (Frontier only) - _ Rental Car Covered inspeetioes - - ' - Automatic transmission/CVT fluid' ` - . - . Axle 8 suspension parts ' Brake Imes 8 cables - ' Brake pads, drums, rotors 8linings - ' Differential oil' - - Drive shaft boots - ' Engine drive belts - Exhaust system ' Front suspension ball joints Fuel lines/connections Fuel tank vapor ven(system hoses - Manual transmission oIl' Propeller shaft (4WD/AWD) Steering gear and linkage Steering linkage ball joints ~ ' Transfer case oil (4WD/AWD) Year 5 Year 6 Year 7 Year 8 Miles 45,000 50,000 55,000 fi0,000 65,000 70,000 )16,000.... 80,000 Months 54 60 66 7E 78 A4 90 96 ` Covered serviees and ropiacements - - ' - - ~ ' - - Replace engine ail and filter - Rotate ores (except Z) - Replace brake fluid - Replace engine air filter Replace In-cabin microfilter' Replace manual transmission ail (Frontier only) - - Rental Car r O:OYeretl i115rleEti00e - - Automatic transmission/CVT fluid" - Axle 8 suspension parts - Brake lines 8 cables - Brake pads, drums, rotors 8linings - - r Differential oil' - t" ' Drive shaft boots' - rt Engine drive belts Exhaust system Front suspension ball joints Fuel lines/connections } to ~y Fuel tank vapor vent system hoses w Manual transmission oil° - - ,w _ I , ~ Propeller eheft (4WD/AWD) :.4n t T~ Steering gear and linkage Y.y.' y(t'=• Steering linkage ball joints ~ t = aY ° ' Transfer case oil (4WD/AWD) - ^ 'Standard equipment an cube, Murano, A15ma (except 2.5 Base), AMma Coupe, Armada Platinum, Pathfinder, 'All front wheel drive, 4W0, AWO models. Fmnfier LE and Pro-4X Off-Road, Maxima, Titan King Cab LE, Ouest, Rogue, Sentra, Versa (except 1.6 Entry) and a cuhe, Murano, Altima, Ntima Coupe, Maxima, Rogue, Sentra, Versa %tema (except X). Optional accessory on all other models. 'Replace (rmt just inspect) ail/fluid if tmving a trailer, using scamper or scar-top carrier, or driving on rough or 'Z, Armada, Frontler, Rogue AWD, Pathfinder, TOaq Xtena, Murano AWO muddy roads NES-PPM-525 0413 6 EXHIBIT A Year 1 Year 2 Year 3 Year 4 Miles 5,000 1J,W0 xa r= 25,000 30,11110 xa Months fi 12 . ¢'4. ' 30 36 ay+$ - #9tl ~ ~ "4,=..+.a ag a':'. ~ rw .,:x a~'4un a.+sz Replace engineeil and filter - - ' ' .4n'D ~Wti ..:ln a+- ~ Rotate tires (except Z) ~ =T ~ ~ 4rya usx - -;y +rrW ffib; ,.t . x.r Automatic transmission/CVT fluid' - .x g;' ~ ,¢qb + _ a~ Brake lines & cables - • . i x. ~ ~ _ Brake pads, drums, rotors & linings am ~Y. Differental oil'' t,. ~ r - Drive shaft boots' -y r+a+ Exhaust system _ w -'+~1' Fuel lines/connections ~ a°'n". r :r ~ - ' ~ Fuel tank vapor vent system hoses ~ ;r t.. ' * $ ~ . ~ ' n+ Manual transmission oiP ss%v v. ' w{ Steering gear and linkage - - ~ ; - Steering linkage ball joints - 1 - +b^" ° r.. . ~ ~ w ~ ~ Transfer case oil (4WD/AWDp ' ` " . - "w Year 5 Year 6 Year 7 Year 8 Miles 45,000 50,0011 x ~ - fi5,000 70,000 Months 54 fi0 >x++92"" 78 A4 ~ COYlrrd.fM'vkr! #atl rya r , ~ * , ..m f w,.. - - w w. Replace engine oil and filter - - Rotate tirea~s (except Z) Ir ' Ky Automatic transmission/CVT fluid' - a, ...i" 3' w~ - ' Brake lines & cables Ai ; w Brake pads, drums, rotors & linings q 'r a w - - `w r_ Differential oil" - e- . Drive shaft boots' - 'v; r; ~:hx e' r w Engine drive belts _23s@ t Exhaust system - - ~gy;e ax+'ry. - - w ~ Fuel lines/connections 'p ~x I Fuel tank vapor vent system hoses x ax+~~ # r ~ p~ Manual transmission oiP - y~x+~ y gX x~d+" - ' Steering gear and linkage - - ' x " 4 s ^ w ~ a~ Steering linkage ball joints k '~.rx° Transfer case oil (4WD/AWD)' - x ax - 2, Armada, Frontier. Rogue AWO, Pathfinder, Titan, Rterra, Alurano AWO. 'Replace (not just inspect) oil/fluid if tmving a tra0er, using a camber or a car-top tamer, or ddving on rough or 'All front wheel tlrrve, 4W0, AWO models. muddy roads. EXHIBIT A Year 1 Year 2 Year 3 Year 4 Miles 5,000 10,0110 2.r 25,000 30,000 Months 6 12 30 3fi .x'`+.'_ ,,,z ~ s v~ - xu Replace engine oil and filter - - # m4 J. p } a~ Rotate tires (except Z) - - +;p ~,r+~N - - - ;q:. Year 5 Year 6 Year 7 Year 8 Miles 45,000 5Q000 4'. ~ a C- 65,W0 70,000 ~ " -k. << <v, Months 54 fi0 ~ sxti. T ~ ~ 7R 84 ` s e,+a+.~. .ras+. , Replace engine oil and t'dter - .+-s'~}'~i u ' Rotate tires (except Z) m ;f~ - - ns~~~ if NES-PPM-525 0413 9 CUSTOMER EXHIBIT A Year 1 Year 2 Year 3 Year 4 Year 5 Miles 6,600 12,000 18,000 21,000 30,000 38,000 12A00 48,000 54,000 60,000 Months 6 12 18 24 30 3fi 4T IB 54 fi0 Coveretl servleef antl rePlaeements Replace engine oil and (filter Replace in-cabin microfilter Replace transmission oil Replace differential oil (rant/rear - Replace engine coolant Replace engine air filter Replace brake fluid Replace spark plugs Replace brake hoses Replace secondary aIr injection filter assy COVered Infl'}ecElons Axle & suspension parts Brake lines 8 cables Brake pads & rotors DlHerential oil (front 8 rear) - Drive shaft boots Driving performance Secondary air injection system - Engine drive belts Engine settings (Balancing of air flow for left 8 right banks) Engine startability 8 abnormal sounds Exhaust system - .v Front suspension ball joints Fuel lines/connections - Fueltankvaporventsystem hoses Transmission oil Measurement & adjustment of wheel alignment ~ Propeller shak k. ~ ! Steering gear and linkage r 6 y- a;{ Steering linkage ball joints r~ ' „ rr, ' Throttle chamber deposits - ~w°,, tl,y [ Transmission settings ~ Key: LEAF 1= 1 LEAF 2= 2 f EXHIBIT A Year 1 Year 2 Year 3 Year 4 Year 5 Miles 7,500 15,660 22,000- 30,008 37,500 45000 5$,Q08 fi7,500 75,000 Months 6 12 48 : ~ 21 : 30 36 " 1'! ` ~ 48 54 60 aR1Y101f #rul 8C0111latf ; . r; Rotate tires 1,2 1,2 i,2 °1, 2' 1,2 1 2 1,Q fi,2' 1,2 1,2 Replace brake fluid 1 ~ ' 1 y' 1 Replace in-cabin microfilter 1, 2 ; 1, 2• 7 2 t, 2' 1,2 Axle & suspension parts 7 7 ' y 4' 1 t t, 2; , i Brake lines &cables 1,2 1, 12 ty 2Y^.' 1,2 Brake pads & rotors 1 1, 2 i 1. 2 1 1 2 2 7~ 2`.. 1 1, 2 Charging port 1, 2 g'. 1 2 Drive shak boots 1 1 2 1' 1,2" 1 1 2 1',',b 1,2",- 7 1,2 Front suspension ball joints 1 1 1 21 1 1 . L 2 1 1 Reduction gear oil 1, 2 1, 2' 1 2 T 2~ 1, 2 Steering gear & linkage 1 1 1 ,.1, $ 1 1 q 2+ . 1 1 Steering linkage ball joints 1 1 4 . ~ 1 1 } 2+ ~ 1 1 EV battery usage repotl' 1 2 1 2 1 2 ' Review of the EV 6a0ery Usage Report is required as a conditlon of EV hattery warranty. Refer to the Nissan LEAF Wananty Information BoolAet for details. NES-PPM-525 0413 g Model Year 2014 and later Security+Plus' PREPAID MAINTENANCE APPLICATION/DECLARATION PRODUCT TYPE ? MB MC DEALER INFORMATION NISSAN ExTENDED SERVICES VEHICLE INFORMATION DEALER NUMBER NORTH AMERICA, G.P. VEHICLE YEAR MAKE MODEL P.o. Box s85ooa NISSAN DEALER NAME FRANKLIN, TN 37068-5004 RTVFRHF4r) AUTCt MAI_' L Tr AGREEMENT NUMBER VEHICLE ID NUMBER (17-DIGIT VIN aTr srATE j ~7 RIVEIRHEAC N1 O O J 3~~ 1 i i - PHONE( t;3~. X69-060a M N 1NQA~@cP9r?+_q,8155 APPLICANT INFORMATION LIENHOLDER INFORMATION LAST NAME FIRST M.I. NAME TOk?v GF SOiITHn~_0 NISSAN ZNFINITS, L7 STREET / P.O. BOX ADDRESS STREET / P.O. BOX ADDRESS =3go;; R?r 25 Pi C~Uti 254o4J CITY . _ l7, ,~I ^ 4, STATE 21P CODE CI STATE ZIP CODE n~ .7, 11"" ~AC:RAMEPJ?v ('A U5855 p,M, yE yy~_,41u~ P.M, gA/~lE `~3.., 4+~,c APPLICANT EMAIL 1\/ •\JMAINTENANCE TYPE l/ 1\LEAF CURRENT ODOMETER READING IN-SER E DATEf NEW NISSAN VEHICLES ONLY (MB) E) ? i ; M H W) ? X) ? PREMIUM (1) PREMIUM STANDARD Y) ? M) ? L) ? TManufacture%s Original New Vehicle Warranty Start Dete BASIC+pWS v. GT-R STANDARD (2) AGREEME PIRATION MILEAGE AGREEMENT EXPIRATION DATE NEW & USED NISSAN VEHICLES (MC) MONTH oar YEAR Z) ? BASIC DEDUCTIBLE AGREEME T, URCHASE PRICE• DA YOU PUR LIASED VE # ' M H UA r R N) © $0 $ seasm aea eesle~Plas Ay,eementstahoate. 'SubieC to slate and local saes taxes where appl.rable Effective 12'.01 A.M. Standard Time at Address ofA hunt PREPAID MAINTENANCE PLAN -TIME/MILEAGE TERMS Please select the coverage you wish to purchase by checking the appropriate box below. Coverage under Standard and Premium Agreements begins on the vehicle's original In-Service Date listed above (i.e., the manufacturer's original new vehicle warranty start date) and zero miles on the odometer. Basic and Basic+Plus Agreement coverage begins on the date you purchase the vehicle (listed above) with the mileage on the vehicle's odometer on that date. In all cases the Agreement expires at the Agreement Expiration Mileage or Agreement Expiration Date expressly listed above. Vehicles which have been in service more than 6 months from the in-service date, or which have more than 7,500 miles on the odometer, are only eligible for Basic or Basic+Plus Agreements. ALL MODELS EXCEPT GT-R, NISSAN LEAF AND NV200 TAXI A) p 12 months / 10,000 miles B) ? 24 months / 20,000 miles C) ? 36 months / 30,000 miles D) ? 48 months / 40,000 miles S) ? 60 months / 50,000 miles T) ~ 72 months / 60,000 miles U) ? 84 months / 70,000 miles W) ~ 96 months / 80,000 miles GT-R ONLY K) ~ 12 months / 12,000 miles L) ? 24 months / 24,000 miles M) ? 36 months / 36,000 miles N) ? 48 months / 48,000 miles O) ~ 60 months / 60,000 miles NISSAN LEAF ONLY F) ? 12 months / 15,000 miles G) ? 24 months / 30,000 miles H) ~ 36 months / 45,000 miles I) ? 48 months / 60,000 miles 1) ? 60 months / 75,000 miles CUSTOMER ACKNOWLEDGEMENT I am applying for the Security+Plus Prepaid Maintenance Plan covering the motor vehicle desclihed in this Application/Declaration. I agree that the time and mileage limits for Standard and Premium Agreements begin from the Original Manufacturer's New Vehicle Warranty Start Date and zero miles on the odometer. Far Basic and Basic+plus Agreements, time and mileage limits begin on the date of purchase and the current odometer reading. Nissan Extended Services North America (NESNA) reserves the right to accept, correct, modify ar refuse any Application/Declaration. NESNA reserves the right to reject any Application/Declamtion for any reason at its discretion upon return of the full amount paid. I agree that my Prepaid Maintenance Agreement isgtjEing issued in accordance with the information container' in this Application/Declaration and is subject to the terms and conditions stated therein. I APPLICANT'S SIGN TURE ~ l7FtE: ' AUTHORIZED DEALER'S SIGNATURE 1. / NESPPM-535 Oa l3 0413 25M CUSTOMER ' _ _ Certificate _ Technolo Insurance Com an Inc. Uader Master Poficy #TIC-NSD-VPP-NY-040112 gY P Yr Issued to A Stock Company Nsdoa Sste Drivers 59 MsideB Lane, 6th Floor Theft Deterrent Product Protection 800 Yamato Road, Suite 100 New York, NY 10038 Bcea Raton FL 33431 Certificate Effective Dste: Month Day Yesr 10 21 2013 GROUP MEMBER DEALER CODE# TOWN OF SOUTHOLD RIVERHEAD AUTO MALL LTD Address Address 1800 OLD COUNTRY RD City State Zip _ City State Zip SOUTHOLD NY 11971 RIVERHEAD NY 11901 Home Phone Bus. Phone Phone Contact 631}298-4460 {631)298-4460 (631}369-0600 Year Make Model VIN# Mileage/Hours 2013 NISSAN LEAF 1N4AZ0CP9DC418165 13 FINANCIAL AGREEMENT LENDER/LESSOR NISSAN - INFINITI, LT Loan Lease Term (Months) Vehicle Purchase Price Address XX 36 31120.00 PO BOX 254648 Etch Price Vehicle Price City State Zip $ N/A $ 31120.00 SACRAMENTO CA 95865 Maximum Limit of Liability: $2,500 FOR INSURANCE COMPANY USE ONLY Coverage Period: 3 Years Lose Benefit: In the event Ore Theft Deterrent Product (TDP) installed on the Covered Vehicle specified in this Certificate fails to prevent the Covered Vehicle from being stolen and such failure results in Total Loea as described herein, We willreimburse the Certificate Holder for those expenses directly related m the theft and replacement of the Covered Vehicle up m the lesser of one thousand five hundred dollars ($1,500) or the "Retail" value of the Covered Vehicle with appropriate adjusnnents for mileage and/or optional equipment as detemrined by the then current, region specified National Automobile Dealers Association (N.A.D.A.) Official Car Guide as of the Date of Lass. Replacement Allowance: In addition, if the Covered Vehicle is declared a Total Losa by Your Primary Automobile Insurance Carver, a benefit of one thousand dollars ($1,000) will be paid to the original selling dealer, to be used toward the purchase of a Replacement Vehicle. Deductlble Relmbunemeut: In the event the TDP failure results in the Covered Vehicle being stolen, but recovered with damage, but not a Total Loss, We will pay You a benefit up to one thousand dollars ($1,000), but limited [o Ore lesser ofi (a) Your actual Primary Automobile Insurance Cartier deductible amomt, or (b) the amount of damage. This benefit is limited to ooly one (I) such payment during the Coverage Period. Rental Eapeuse: If Yoar Covered Vehicle is stolen, We will reimburse You for car rental expenses up m twenty five dollars ($25) per day (excluding taxes and insurance) until Your Primary Automobile Insurance Cartier provides a rental vehicle or settles Your claim up m a maximum period of ten (10) days. The maximum benefit over the Coverage Period is two hundred fitly dollars ($250). DEFINITIONS For Ore purpose of this Certificate Ore following terms shall mean: • Adminlatretoq Master Policyholder means the company listed above the application section of [his Cerdticate who manufactures or distributes a TDP and administers this Certlncate. • Cer[iflcate mesas a document issued to You, which specifies the definitions, exclusions and terms and conditions of the coverage. • Certlflcah Efiectlve Date means the date You purchased the TDP and the date this Certlflcah begins: • Certificate Holder, Yoa Your means the purchaser of the Covered Vehicle as listed in the application section of this Certificate. It also means an individual who has purchased the Covered V'ehide from the onginal Certlflcate Holder and has fomtally transferted the Cerdflcate. • Coverage Perled means Ore period of time Drat this Certlflcate shall be yr effect form the Certificate Effective Date until the earlier of the expimdon of the coverage period or unOl We have made a claim payment order this Certificate. • Covered Vehicle means the four-wheeled pereonal passenger vehicle, van, pickup or a light track or recreational vehicle, as listed in the application section of this Certificate which has had the TDP applied to or installed end for which Yeu have paid a premium to Ore Admiuiatrator. • Date of Imes means the date on which the theft of theCovered Vehicle occurred. If such date is not determinable, the Date of Lola shall either be the date established by the Primary Automobile Insurance Carrier or the date the theft was reported to the police, whichever is earlier. • Poncy, Territory means Ore United States of America, its territories or possessions or Canada. • Replacement Vehicle means the vehicle You purchase or lease under the temrs of this Certificate as a replacement for Your Covered Vehicle. • Total Lola means Yoar Primary Automobile h~surence Cartier has declared the Covered Vehicle a Total Loss es a direct result of theft. • We, Us, Oar means the Lrsumnce Company issuing this Ceraflnte and is listed above the applicaton section of this Certificate. • Stolen Vehicle meansthe Covered Vehicle shell be considered stolen for p, oses of a Loan Beusflt under this Certlncate after the occurrence of the Following: I) You must have reported the theft within fifteen (15) days to the police having junction of the matter and to the Admidatrator narrred on the Certificate within forty five (45) days of the theft; 2) Thirly (30) days must have passed after the Date of Loas without the Coverted Vehicle having been recovered or, if recovered, is declared a Total Loss by Yoor Primary Automobile Insurance Carver, and 3) You must have wmprehensive physical damage insurance m effect with a Primary Automobile Insurance Cartier and must receive an insurance claims settlement by reason of the un-recovered Oreft or declaration that Your Covered Vehicle is a constmc[ive Tohl Lola. THI6 PRODUCT DOES NOT AFFORD PROTECTION AGAINST BODILY INJURY OR PROPERTY DAMAGE, NOR DOES IT FULFILL THE FINANCIAL RESPONSIBH.ITYLAWS. IS FRODUCT DOES NOT ELIM THE NEED FOR AN AUTOMOBH.E INSURANCE POLICY. Sr Date `7 r Date 10/21/2013 NSD1382984 NY_3 Yr/2,500_12/l l White -Administrator Yellow -Dealer Pink -Customer 293 TERMS AND CONDITIONS A) The Coverage Period wmmences on the Certificate EHectlve Date and continues fur three (3) years, unless otherwise terminated in xcordance with this Certificate. B) You must purchase and maintain for the full Coverage Period of this Certflcate, comprehensive physical damage insurance on the CovereA Vehicle for limits a[ leas[ equal to the actual cash value of the Covered Vehicle, failure: to do so will void this Certificate. C) Since the TDP is permanently installed on the Covered Vehicle, this Certificate is noncancelable and nonrefundable. D) You may trarlsfer this Certificate at the time You sell Your Covered Vehicle, by written request to the Administrator within fiReen (15) days of the Covered Vehiole resale dam. Copies of new registered title and bill of sale must accompany the tranefer request E) When We make a payment fur a Loss Benefit under this CerUflcete for the Covered Vehicle, covembre order this Certflcate will cease and will cause this Certificate to expire. DUTIES IN THE EVENT OF LOSS I. Give m the Admiuiatretor prompt notice of the toss. Include n description of the Covered Veh[cle involved. 2. If requested, permit the Administrator m question You under oath, at such times as may be reasonably required, about any matter relating to this Certificate. 3. Promptly send the Administrator any legal papers or notices received concerning the loss. 4. Cooperate with the Administrator in the investigation or settlement of the claim. 5. You will not, except at Your own cost, volunurily make a payment, assume an obligation, or hrcur any expense without Our consent. CLAIM REQUIREMENTS Yoa must report Ore tbeft of the Covered Vehicle to law enforcement authorities within twemty four (24) hours of knowledge of the theft. You must contact the Administrator within fifteen (I S) days after the Date of Loss has been confirmed by the primary carrier and must provide dre following information to the Administrator within forty five (45) days after [he Date of Loss has been confirmed by the primary carrier [o: NIU of Florida, inc. - 800 Yamato Road, Suim 100 Baca Ratoa, FL 33431 (888)684-9327 Documentation must include: 1. Copy of this Certificate; 2. Copy of police report evidencing the Covered Vehicle reported as stolen; 3. Copy of the purchase or lease agreement for the Replacement Vehicle; 4. Verification from Vour Primary Automobile Insurance Carrier substantiating the date and cause of loss and a copy of the settfemcmt check;. 5. Paid Rental Receipt Your claim cannot be processed until the Administrator has received all of the above in fully legible Form. Upon receipt and validation of the claim by the Admiaistratoy a letter confntning the payable benefit will be sent m You and the authorized dealer which states payment will be made when proof of purchase and delivery of the Replacement Vehcle, is provided. You moat be the person who purchases [he Replacement Vehicle. LOSS PAYMENT We will pay or make good on any Total Loss covered under this Certificate within thirty (30) days after: LYou have fully comphed witlr ell the corms and conditions of this Certificate; and 2. Yoa have provided to Administrator satisfactory documentation concerting the Total Loss; end 3. We reach an agreement with You. EXCLUSIONS W e will not pay a Loss Benefit; 1. For any Total Loss resulting directly or indirectly from any dishonest fraudulent or criminal act by You and/or Your family members. 2. Far any Total Loss or damage resulting from war, whethcK or not declared, invasion, civil waz, insurrection, rebellion, or revolution, nuclear radiation or radioactive conmmination. 3. For any Total Losa if no Primary Automobile Insurance is in effect on the Date oT Loss. 4. For any Total Losa resulting from theft occnrting prior m the Certificate Effective Date. 5. For personal property located in or on the Covered Vehicle. 6. For any Total Loss when Your Primarv Aummobile Insurance Carrier has not paid or refuses to pay any monies for the theft of Your Covetxd Vehicle. 7. Coverage may not duplicate other applicable coverage You may already have. 8. For any Total Loss when You do not provide notice to the Administrator within fifteen (15) days of the Date of Loss or provide necessary documentation to the Administrator within forty five (45) days from the Date o[ Loss. SUBROGATION In the event of any payment under this Certificate, We shall be subrogated to all Your rights or recovery therefore against any person or organization and You will cooperate in securing sxh rights. You shall do nothing after the Total Losa to prejudice such rights. ARBITRATION ff We and You disagree on any respect of a provision of this Certlflw[e, or a claim under this Certificate, the following provisions apply: 1) Either party may make a written demand for arbitration of [he dispute; 2) The arbitration will be executed pursuant m the rules and procedures of the American Arbifratidn Association; 3) There shall be three (3) arbitrators. Exh of us will select the one from the list of five or more candidates supplied by the American Arbitration Association. If the two (2) arbitrators cannot agree on an umpire, the final decision as to the selection of [he umpire will be left to the American Arbitration Associatioq 4},Any findings of fact, or conclusion of law, or award, which are agreed upon by the umpire and one of the arbitrators will be binding; 5) Time limitations in the Claims ljeporting and Settlement and Suit Conditioos will be tolled from the date of a written arbitration demand until the issuing of any findings as described in (4) above; 6) In Ore case of an azbitration demand by Us, We will pay all cost and expenses of the proceedings, the umpires' fees and the fees of the other two (2) abitrators. We wi)I not pay legal fees, or consultant fees, incurted by You; 7) In the case of an arbitration proceeding demanded by You, We will share [he cost and ezpenses of the proceedings and the fees of the umpire. Each of us wilt pay the fee of the arbitrator selected by ourselves. EXAMINATION UNDER OATH: The Administrator and You shall submit, and so far as is within his, her, or their power, shall cause all other persons interested in the loss and members of the household and employees [o submit to examinations under oath by any persons named by Us, relative to any and all matters in connection with a claim. The Administrator and You shall produce all books of account, bills, invoices, and other vouchers or certified copies thereof if originals are lost, at such reasonable time and pl xe es maybe designated by Us and shall permit extracts and copies thereof to be made. LEGAL ACTION AGAINST US No one may bring legal action against Us or the Administrator under this Certificate unless: 1. There has been full compliance wittt all the terms of this Certificate; and 2. The xtion is brought within sbr (6) years after loss. CANCELLATION OF THE MASTER POLICY Iu the event the maser policy is cancelled and provided Your Certificate Effectlve De[e is prior to the cancellation date of the master policy and Your premium has been submitted to Us, cancellation of the maser policy shall not affect Our duties or rights, or the duties or rights of the Administratoq Masmr Policyholder. 3913 $%9BatUrCLEASE'° NISSAN MOTOR ACCEPTANCE CORPORATION LEASE 0. Agreement To Provide Insurance - CT/MA/NJ/NY/PA/VT DATE: lg/Z1/21D13 TO: NISSAN MOTOR ACCEPTANCE CORPORATION ("NMAC") AS SERVICER FOR NISSAN-INFINITI LT Our vehicle lease agreement requires that I buy insurance which provides (a) comprehensive (maximum deductible $1,000), (b) collision (maximum deductible $1,000), (c) property damage liability (minimum $50,000 per occurrence), and (d) bodily injury liability (minimum $100,000 per person and $300,000 per occurrence). I agree to provide written proof of such coverage to NMAC and/or its agents when and if requested to do so. I have arranged for the required insurance from the insurance company shown below. The policy will name Nissan-Infiniti LT and its trustee, NILT, Inc. as loss payees on coverages (a) and (b) and will provide Nissan-Infiniti LT and NILT, Inc. with primary coverage as additional insureds on coverages (c) and (d). DEALERSHIP:RZVERHEl+C~ AUTO MALL LTG DEALERSHIP PHONE: (631 }369-05~I0 FINANCE MANAGER: cNarsTTNa ee c~ NNrSr LESSEE: T6~k'iJ 8f SuUTHA6B ADDRESS:~~ggS RTF-=a9UTH966 NY 11z'l HOME PHONE: (y3} I~yg-4488 BUSINESS PHONE: 'a~I-I?'~t~4150 YEAR:~g33 MAKE:NJgggN MODEL: tr_AF VALUE: 312241_ VIN: I_~N i 4~A~~g I I p I D~~q ' } I ra I } I S ' - I PLANNED DELIVERY DATE: i a % ___,.~?a~_~ AGENT:ROV U REEVE hrEtJrV 1N6 AGENT PHONE: iy~la9b-47g(~ AGENCY NAME: li SpE61:ALTV 1N"}1RAN6E AGENCY ADDRESS: "E1-803f 54 tbl'7~Tt1~K Ny 3}95c INSURANCE COMPANY: r:, r.:~~:~..,~~ POLICY#: -,pl;g8gg3g}gq EFFECTIVE DATE: EXPIRATION DATE: gj fg}~ 14 DEDUCTIBLES: COMPREHENSIVE: SAygg.gg COLLISION: yggg,gg B.I. LIMITS: P.D. LIMIT: NISSAN-INFINITI LT AND NILT, INC. ? Yes NISSAN-INFINITI LT AND NILT, INC. ? Yes LISTED AS ADDITIONAL INSUREDS: ? No LISTED AS LOSS PAYEES: ? No ADDITIONAL INSUREDS & LOSS PAYEES MUST READ: LESSEE fay s~ ~ n ,¢,,u~.g, . ; v.~<.w.w'z SIGN HERE: n -ems f,?u>.e - NISSAN-INFINITI LT AND NILT, INC. ~ CO-LESSEE .-4f~ vey6}~G.~c. _..4~~~ ' R,,.1':' . _ P.O. BOX 390889 SIGN HERE: MINNEAPOLIS, MN 55439-0889 - DEALER/SALESPE SON SIGN HERE: DEALER SERVICE: 1-800-562-6143 INSURANCE VERIFIED BY: DATE: NILT/N 3175-VL 7/05 ® II~~~II~I~III~~~~~III~~III~I~III~I~I~I~I~III~III~~~II~III~~I * N-CPINSAGR LESSEE S%91Ia>tU~@LEASE"- NISSAN MOTOR ACCEPTANCE CORPORATION Special Insurance Notice -New York If your vehicle is confiscated or if you fail to maintain adequate insurance coverage or otherwise default under the lease you will be signing, you will be liable for the difference between the actual cash value of the vehicle as determined by the insurer and the early termination balance as disclosed in Section "Early Termination" of the lease. Otherwise, NMAC, as servicer for Nissan-Infiniti LT, will accept the insurance loss proceeds in full satisfaction of your remaining lease installments as disclosed in Section "Damage, Loss or Potential Loss of This Vehicle" of the lease. Leasee__ TOWN OF SOUTHOLD ,g Date 10~ 21 ~ 20i3 Lessee '`-~+~-~n ~O -~K^.'~"a"'q' Date 7-~ ~ - - v AVISO ESPECIAL DE SEGURO -NEW YORK (SPANISH TRANSLATION) Si su vehiculo es confiscado o si usted no cumple con su obligaci6n de mantener el seguro adecuado o falta al pago del contrato de arrendamiento que usted esta firmando, usted sera reponsable por la diferencia entre el valor actual del vehiculo segGn sea determinado por el asegurador y el balance sobre la terminaci6n prematura, seglin to determina la Section "Termination Prematura" del contrato de arrendamiento. De to contrario, NMAC, Como administrador de Nissan-Infiniti LT, aceptara el producto sobre la perdida total, en cumplimiento total sobre el restante de pagos en su contrato de arrendam~ento, seglin describe la Section "Dario, P~rdida o Perdida Potential de Este Vehiculo"del contrato de arrendamiento. Aaendatario Fecha / / Anendatario Fecha / / III~~~IA~~I III ~I * N-CPINSNOTNY NILT/N 3040-NY 1/99 ® WHITE COPY-NMAC CANARY COPY-LE66EE (ARRENDATARIO) PINK COPY-DEALER (COMERCIANTE)