Below is a quote I requested while the conversion was in progress
QUOTE AND ACTIVATION FORM
CSP RESPOND IMMEDIATELY
The Rates shown below will expire at MIDNIGHT on Dec/18/2005
— Continued Service Plan from Affinity Brokerage, Inc.
DAVE B Quote Number: 111111111 631 SMB DR Policy Type: CSP
Fresno , CA000000 Member Number
Phone Number: 123456789 Please send me RV related information. Email Address:________________________________________________________
1. Vehicle Information: Verify that all information in this section is correct. Your quote is based on this data.
Vehicle Type: Motorhome Class B Van Current Retail Value: $108,000.00
Purchase Date (1st Owner): 12/19/2005 Current Odometer Reading: 84
Model Year: 2006 Under Mfg. Warranty?: Yes
Make and Model: Sportsmobile Sportsmobile Mfg. Warranty Term: 36
Engine Type: Diesel Four-Wheel Drive: Yes
Engine Location: Front engine
2. CSP Deductible and Premium
If you would like to choose a Term: One Year Extension Your Deductible is: Monthly* Total
deductible other than the one quoted, Starts: Dec/19/2005 3 $100 Deductible: $ 91.13 $ 1,073.00
please call 1-877-841-8532. Ends: Dec/18/2009
3. CSP Options: All options listed are INCLUDED with CSP Gold.
If you want to make any changes
to your CSP Quote, please call
1-877-841-8532.
Slide Out Room Unit $ 7.13 $ 84.00
Leveling Jack System $ 7.13 $ 84.00
Powerstep System $ 2.04 $ 24.00
Deluxe Component Coverage $ 8.15 $ 96.00
Entertainment Package $ 15.29 $ 180.00
Premium Tax $ 2.94 $ 34.60
Here's your TOTAL Payment Amount >>> $ 94.07 $ 1,107.60
*Based on a 31-day month
4. Choose your Payment Option to activate your coverage.
MONTHLY DIRECT PAYMENT
Checking Account Credit Card
Charge in monthly payments to my Checking
Account. A check for the first payment of $ 93.93
(payable to CSP) is enclosed. Future premium
payments will be made from the account until I
instruct otherwise.
Charge in monthly payments to my credit card. I've
included my credit card information (see below).
Future premium payments will be made from this
account until I instruct otherwise.
TOTAL ANNUAL PREMIUM
By Check Credit Card
Check enclosed for $ 1,107.60 (payable to CSP). Charge $ 1,107.60 to my credit card. I've included
my credit card information (see below).
If you chose to pay by credit card, please complete the following:
Charge to my credit card: VISA MasterCard Discover American Express
Credit card number: / / / /- / / / /- / / / /- / / / /
Expires: / /- / /
If you have questions or would like other payment options, please call 1-877-841-8532
Lock in your low CSP rate now and try it out RISK-FREE for 30 days!
3All three(VIN#,SIGNATURE ,& DATE) must be included to start coverage:
VIN#:
3
SIGNATURE
3
DATE:
3
CSP was designrd for the Good Sam Club by Affinity Brokerage, Inc. SP3494
TERMS AND CONDITIONS OF THE MASTER POLICY
OF INSURANCE ISSUED TO THE GOOD SAM CLUB Motorhome
CONTINUED SERVICE PLAN COVERAGE SECTION
These Terms and Conditions of the Master Policy issued to The Good Sam Club and your Evidence of Insurance, hereinafter referred to as the
Coverage, are among The Good Sam Club, hereinafter referred to as WE, US and OUR, our insurance company, and the Purchaser, hereinafter
referred to as You and Your, and provides Coverage recorded for the time and mileage, whichever occurs first, as stated in the Evidence of
Insurance. This Coverage constitutes Your entire agreement and supersedes any and all previous agreements whether written or oral and any other
representations made by anyone in any form.
The limits, terms, and conditions of Your Coverage are important. You should read and understand the terms and conditions below.
MECHANICAL BREAKDOWN COVERAGE
We will provide payment to Your Repair Facility or reimburse You for reasonable costs of labor and materials (approved and receipted) to repair or
replace any of the covered parts under this Coverage if required due to Mechanical Breakdown. A "Mechanical Breakdown or Breakdown" is
defined as failure of a defective covered part or faulty workmanship of a covered part as originally supplied by the manufacturer and under normal
service. A covered part has failed when it can no longer perform the function for which it was designed solely because of its condition and not because
of the action or inaction of any non-covered parts. Replacement will be made with like kind and quality to include rebuilt or remanufactured
parts. Parts may be upgraded to “new” at owner’s expense . Coverage includes fluids when required as part of a covered repair. Coverage
includes manufacturer's deductible when paid by the contract holder for a covered repair. You must maintain Your Vehicle in accordance with the
service requirements set forth in these Terms and Conditions to keep this Coverage in force. Evidence of proper service will be required in the event
of a claim. (See “Your Responsibilities” on the reverse side)
In the event of a Breakdown, You must pay the deductible as stated in the Evidence of Insurance for each visit and pay any non-covered expenses.
TRIP INTERRUPTION
You will be reimbursed for up to ten (10) days of (receipted) expenses for meals , lodging and rental car costs incurred by You and Your family while
staying at a hotel/motel or campground in case a Mechanical Breakdown causes a delay en route. To qualify for this benefit, you must not be able to
utilize Your Motorhome due to a Mechanical Breakdown covered under this Coverage and You must be more than one hundred (100) miles from
home, unless your Motorhome is your sole domicile.
The covered period will begin on the date of the Mechanical Breakdown and one (1) day of travel benefits will be paid for each eight (8) hours, or
portion thereof, of authorized labor time required to complete the repairs. Up to two (2) days will be included in the event an inspection by an outside
source is required to determine if repairs are covered under this policy. No travel benefits will be paid for delays beyond the control of the repair facility,
such as waiting for parts shipments.
Expenses will be reimbursed up to $100.00 per day for meals and lodging and up to $60 per day for rental car costs.
CHASSIS COVERAGE
Coverage applies only to the parts listed herein.
1. ENGINE ASSEMBLY - All internally-lubricated parts, including: pistons, pins, and rings; connecting rods and bearings; crankshaft and main
bearings; camshaft, followers and cam bearings; push rods, valves, springs, guides, seats and lifters; rocker arms, shafts, and bushings; timing
gear, chain or belt, tensioners, and retainers; eccentric shaft; oil pump; engine head(s) *, engine block*, and cylinder barrels*. Also covered are
the following: water pump; Mechanical fuel pump; oil pan; intake and exhaust manifolds; engine mounts and cushions; engine torque strut,
timing cover; valve cover(s); harmonic balancer; flywheel (flexplate) and flywheel ring gear; vacuum pump; dipstick and tube; and all pulleys.
DIESEL ENGINES ONLY - Engine - All covered engine parts shown above plus fuel injectors (except for wear and tear and contamination), fuel
injection pump, and fuel heater. Turbo Charger - All internally-lubricated parts contained within the turbocharger housing. Turbocharger housing
is covered if damaged due to the failure of an internally-lubricated part. Air Brakes - Compressor, diaphragm, treadle, disc caliper, compensating
valve, and slack adjusters. Transmission - Electronic Shift Control Module (The liability for this component shall not exceed $1,500.00 in total).
2. TRANSMISSION ASSEMBLY - Transmission case*; torque converter and all internally-lubricated parts thereof; vacuum modulator; internal
linkage; mounts; oil pan; cooler and cooler lines, filler tube and dipstick.
3. DRIVE AXLE ASSEMBLY (Front and Rear) - Differential housing*; transaxle housing*; final drive housing*; and all internally-lubricated parts
thereof; plus axle shafts; constant velocity joints; universal joints; drive shafts, supports, retainers, and bearings; and hub bearings.
ADDITIONAL COVERAGE, BENEFITS, EXCLUSIONS, LIMITS AND CLAIM INFORMATION LOCATED ON THE REVERSE SIDE
CSP-LP2497(09/05) Motorhome
4. SUSPENSION ASSEMBLY - Strut bar and bushings; upper and lower control arms, shafts, and bushings; upper and lower ball joints; steering
knuckles; wheel bearings; stabilizer shaft, linkage and bushings; kingpin and bushings; torsion bars; spindle supports;compressor, lines, and
bags.
5. STEERING ASSEMBLY - Gear housing*, and all internally-lubricated parts of the steering gear box; the rack and pinion gear; power steering
pump; main and intermediate steering column shafts and couplings; cooler and cooler lines; power cylinder; Pitman arm; idler arm; tie rod and
tie rod ends; drag link; control valve and cylinder.
6. AIR CONDITIONING ASSEMBLY - Compressor; clutch; clutch pulley; clutch coils; condenser; evaporator; POA valve; accumulator; orifice
tube; temperature control programmer; power module; idler pulley and bearing; receiver-dryer; blower motor; high/low cut off switches, pressure
cycling switch; and ducts.
7. BRAKING ASSEMBLY - Master cylinder; power assist booster; wheel cylinders; combination valves; hydraulic lines and fittings; disc calipers;
power brake cylinder; backing plates; clips, springs and retainers, self-adjusters; parking brake linkage and cables; and rear actuators.
8. ELECTRICAL ASSEMBLY - Starter; starter drive; alternator; voltage regulator; distributor; solenoid, relays; manually operated switches; wiper
motors; gauges; window motors and controls; radio power antenna and motors; seat motors and controls; power door locks; cruise control
transducers, engagement switch and servo; turn signal switch; dashboard clock; and dual battery paralleling switch; and thermometer.
9. ELECTRONIC HIGH-TECH ASSEMBLIES - Fuel injection sensors, control module, and injectors; electronic ignition module; electronic
anti-detonation sensors and controller; electronic driver information display; back-up camera and monitor; electronic mixture control unit and
sensors; electronic anti-lock brake system (ABS).
10. HEATING/COOLING ASSEMBLY - Water pump, including impeller shaft, bearings and bushings; heater core; fan; fan clutch; fan motor and
controller module; coolant recovery unit; fan shroud; and electric block heater; heater ducts and cabins.
11. FUEL DELIVERY ASSEMBLY - Fuel pump; fuel tanks; metal fuel lines; fuel distributor; fuel injection pump; fuel injectors; booster pump; and
auxiliary tank switch.
12. CHASSIS FRAME - Permanently attached (welded) metal components only.
*If damaged by the failure of an internally-lubricated part.
SEALS AND GASKETS are covered for all of the components that are listed as covered in the Evidence of Insurance for units with an odometer
reading of less than 50,000 miles AND a model year no older than the year the claim was made minus (5) years.
COACH COVERAGE
Coverage applies only to the parts listed herein.
13. WATER HEATER/BOILER ASSEMBLY - Burner assembly; tank; thermostat; thermocouple; gas valve; electronic ignition assembly; manually
operated switches; and PC board.
14. WASTE SYSTEM ASSEMBLY - Shower; toilet; sink(s); holding tanks; gate valves; and connections.
15. FRESH WATER SYSTEM ASSEMBLY - Water pump; compressor; water tank; water lines; traps; fittings; and faucets.
16. AIR CONDITIONING ASSEMBLY - Compressor; condenser; evaporator; accumulator; expansion valve; thermostat; receiver-dryer; blower
motor; high-low cut off switches; pressure cycling switch; relays; fans; capacitors; and PC board.
17. RANGE AND OVEN ASSEMBLY - (Gas, Electric, Convection, Microwave) Burner assembly; thermostat; thermocouple; burner valves; ignition
assembly; power hood; PC board; magnatron tube; microwave touch pad; circulating fan and motor; connections and fittings.
18. L.P. GAS SYSTEM ASSEMBLY - Regulators; gas bottles (except valves and gauges); mounting brackets; pigtails; L.P. lines; and fittings.
19. HEATING SYSTEM ASSEMBLY - Furnace, ignitor; burner assembly; thermocouple; gas valve; thermostat; blower motor; and PC board.
20. REFRIGERATOR ASSEMBLY - Thermostat; thermocouple; refrigerator/ freezer cooling unit; refrigerator icemaker; burner assembly; ignitor;
PC board; and eyebrow PC Board.
21. AUXILIARY POWERPLANT/GENERATOR/ELECTRICAL ASSEMBLIES - All internally-lubricated parts of the power plant engine; plus the
starter motor; switches; generator rotor and stator assembly; voltage regulator; PC board; head and cylinder block (if damaged by the failure of
an internally-lubricated part); fuel pump; and carburetor. Factory installed 110/220V electrical system (except any wiring, cords and reels) ,
including breaker box and breakers, outlets; power converter/inverter, and auxiliary generator monitor panel.
SEALS AND GASKETS are covered for all of the components that are listed as covered in the Evidence of Insurance for units with an odometer
OPTIONAL COVERAGE
Coverage applies only to the parts listed herein.
22. DELUXE COMPONENT COVERAGE (NEW UNITS ONLY) - Stand-alone Freezer, dishwasher, washer/dryer, stand-alone icemaker, trash
compactor.
23. FACTORY INSTALLED, OR FACTORY-APPROVED DEALER-INSTALLED, STATIONARY LEVELING JACK SYSTEM - Mechanical,
electrical, and hydraulic components.
24. SLIDE OUT ROOM UNIT (S) - Mechanical, electrical, and hydraulic components, including generator slide out. (Excludes slide-out room
weather seals and boots).
25. POWERSTEP SYSTEM - Mechanical, electrical, and hydraulic components.
26. ENTERTAINMENT PACKAGE - Televisions, VCRs, audio system, motorized dish antenna, TV antenna (The liability for the audio system shall
not exceed $600.00 in total).
SEALS AND GASKETS are covered for all of the components that are listed as covered in the Evidence of Insurance for units with an odometer
reading of less than 50,000 miles AND a make model no older than the year claim is made minus (5) years.
ADDITIONAL COVERAGE, BENEFITS, EXCLUSIONS, LIMITS AND CLAIM INFORMATION LOCATED ON THE NEXT PAGE.
CSP-LP2497(09/05) Motorhome
WHAT IS NOT COVERED
* Any preexisting problems that are present prior to the purchase
of this Coverage. The condition of the covered part(s) in
question will be assessed to determine time of initial breakdown
* Gradual reduction in operating performance due to wear and
tear.The policy's intent is to provide coverage for sudden and
unforeseen breakdowns.
* Mechanical Breakdowns outside the United States and
Canada.
* Any loss resulting from inadequate amounts of coolant,
lubricant, or fluids.
* Any loss caused by racing, commercial use, or delivery
purposes, or by pulling a trailer weighing more than the
manufacturer's recommend limits.
* Mechanical Breakdowns covered by manufacturer's warranty,
manufacturer's recall, or factory bulletins, (regardless of
whether or not the manufacturer is doing business as an
ongoing enterprise), any vehicle Service Agreement, other
Service Agreement, written warranty, or any valid and
collectable insurance policy.
* Damage to a non-covered part by a covered part(s) or to a
covered part by a non-covered part(s) failure.
* Any covered part which is not broken down but which a repair
facility recommends or requires be repaired or replaced.
Suggested or necessary upgrades or replacements are not
covered.
* Any loss caused by improper or contaminated fuel or other
fluids.
* Any loss caused by negligence, misuse, abuse,impact or
collision damage or from any other cause whatsoever, except
as provided under this Coverage.
* Any loss or expense if the odometer has been tampered with,
altered, or is inoperative.
* Any repair for the purpose of correcting the engine compression
or correcting oil consumption when a Mechanical Breakdown
has not occurred. Valve grinding and/or worn rings are not
covered.
* Any replacement costs of filters, fluids, sealing boots, and seals
or gaskets, except as provided under this Coverage.
* Any loss caused by any alterations not meeting manufacturer's
specifications.
* Any failure, malfunction, defect, inoperability, breakdown,
disruption or stoppage of any product, function or related
component caused by the electronic date change to the year
2000, or any other date change including leap year.
* The replacement of an entire system due to obsolescence or
unavailability of the failed covered part(s).
* Alignments, adjustments, tune-ups.
* Any damage or failure resulting from rust , corrosion or
freezing.
* Any damage or failure resulting from Acts of God, power
surges, collision, upset, or any damage from a non-covered
source.
LIMIT OF LIABILITY
The total of benefits payable to You and the liability of Our insurance company under the Terms and Conditions of the Master Policy of
Insurance issued to The Good Sam Club shall in no event exceed the current market value of Your vehicle before Breakdown.
OUR LIABILITY TO YOU AND THE LIABILITY OF OUR INSURANCE COMPANY FOR INCIDENTAL AND CONSEQUENTIAL DAMAGES
INCLUDING, BUT NOT LIMITED TO, PROPERTY DAMAGE, DAMAGE TO A NON-COVERED PART(S), LOSS OF USE TO DESCRIBED
VEHICLE, LOSS OF TIME, INCONVENIENCE, AND COMMERCIAL LOSS RESULTING FROM THE OPERATION, MAINTENANCE, OR USE OF
THE DESCRIBED VEHICLE OR FROM THE BREACH OF ANY IMPLIED WARRANTIES ARISING BY OPERATION OF LAW, IS EXPRESSLY
EXCLUDED.
IN THE EVENT OF BREAKDOWN
Follow These Claim Procedures:
1. Call Us for instructions prior to proceeding with repairs. (We reserve the right to inspect all repairs to determine coverage.)
2. Present the Evidence of Insurance, Terms and Conditions, and required Maintenance Records to the Repairing Dealer.
3. Prior to proceeding with repairs, ensure the Repairing Dealer calls Us with an estimate of repairs and receives an authorization number from
Us.
NOTE: In the event of a Breakdown occurring when Our office is closed, You may follow the claim procedures in these Terms and Conditions without
prior authorization, and reimbursement will be made to You or the repair facility in accordance with policy provisions. You must call the Administrator's
office within five (5) business days from the date of repair to determine if such repair will be covered by this Coverage.
NATIONAL CLAIMS NUMBER: (888) 861-8697 Hours: 8:00 AM to 5:00 PM Mountain Time Monday-Friday
IMPORTANT!
. You assume all liability for payment of unauthorized repairs and benefits.
. Liability for teardown rests with You on non-covered parts.
. You must submit each claim, with supporting documentation and proper maintenance records to the repairing facility and the Administrator,
within ninety (90) days after the failure date of each claim in order for a claim to be eligible for coverage consideration pursuant to this
Coverage.
YOUR RESPONSIBILITIES
To receive the full benefits of this Coverage, You must at Your expense:
1. Have the vehicle serviced as recommended by the manufacturer for severe service or extreme conditions. Failure to perform the
aforementioned maintenance will result in claim denial.
2. Keep a record of maintenance validated (signed and stamped) by the licensed repair facility, and keep receipts and work orders showing date,
mileage, and service performed. For services done by You, keep a personal maintenance record with date, mileage and services performed
including any receipts for products purchased to carry out that aforementioned maintenance. Failure to retain receipts and supply them to
CSP, when requested, will result in claim denial.
CANCELLATION / TRANSFER
Cancellations: This Coverage applies only to You and the Vehicle described in the Evidence of Insurance. In the event of cancellation of this
Coverage within 30 days of the purchase of the Coverage, We agree to refund the full purchase price to You, less any paid or approved claims. If this
Coverage is canceled beyond 30 days from the date of purchase of the Coverage, We will calculate and make a pro rata refund based on time, less
an administrative fee of $50.00. Any lien holder will be named on the cancellation refund check as their interest may appear. All requests for
cancellations must be received in writing, and must include the Evidence of Insurance, the current mileage, and the signature of the contract holder.
We may cancel this Coverage for (1) Nonpayment of the premium or (2) Intentional misrepresentation or fraud in obtaining this Coverage or in the
submission of a claim.
Transfers: In the event this Coverage is not canceled, it may be transferred to an individual for non-commercial use to whom You sell the vehicle
while this Coverage is in force. This can be done only if You send the Administrator copies of the validated (signed and stamped by the licensed
repair facility) maintenance record for the required servicing, and the name and address of the new Purchaser within 30 days of change in ownership.
If any portion of the premium remains unpaid at the time of the transfer, the new Purchaser must agree in writing to assume the responsibility for
payment of the balance of the premium.
CSP-LP2497(09/05) Motorhome
NOTICE:
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS
BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE
STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED
"NONADMITTED" OR "SURPLUS LINES" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO
CALIFORNIA LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE
INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA
LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR
CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER
BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS
AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU
SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT,
BROKER, OR SURPLUS LINE BROKER OR BY CONTACT THE
CALIFORNIA DEPARTMENT OF INSURANCE AT TOLL FREE
1-800-927-4357.
DATE
INSURED (Signature)
PLEASE PRINT NAME
POLICY NUMBER
D-1 FORM (8/2001) LP1803