Employee
BARNWELL INDUSTRIES, INC.
AMENDED AND RESTATED 2018 EQUITY INCENTIVE PLAN
RESTRICTED STOCK UNIT AWARD MEMORANDUM
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[_________]
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Number of Restricted Stock Units
(Shares of Common Stock) Subject to Award:
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[____] shares of common stock
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Subject to the terms of the Restricted Stock Unit Award Agreement, the Restricted Stock Units shall vest and become
nonforfeitable in accordance with the following schedule:
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•
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[________]
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Additional terms and conditions of your award are included in the Restricted Stock Unit Award Agreement (the “Agreement”). As a
condition to your receipt of this award, you must accept the terms and conditions of this award within 90 calendar days of your Grant Date by countersigning the Agreement and returning it to the Secretary of Barnwell Industries, Inc. If you do not
accept the terms and conditions of this award within such time, this award may be forfeited and immediately terminate.
Under the terms of the Restricted Stock Unit Award Agreement, your Death Beneficiary is the person you have designated in accordance with the
Company’s procedures, and if you have not designated anyone, your estate.
BARNWELL INDUSTRIES, INC.
AMENDED AND RESTATED 2018 EQUITY INCENTIVE PLAN
Restricted Stock Unit Award Agreement
This Restricted Stock Unit Award Agreement (this “Agreement”)
is between Barnwell Industries, Inc., a Delaware corporation (the “Company”), and you, the person named in the Restricted Stock Unit Award Memorandum (the “Award Memorandum”) who is an employee of the Company or a Subsidiary of the Company (the “Participant”).
For purposes of this Agreement, “Employer” means the entity (the Company or Subsidiary) that employs the Participant on the applicable date. This Agreement is effective as
of the Grant Date set forth in the Award Memorandum.
The Company wishes to award to the Participant Restricted Stock Units representing the opportunity to earn a number of Shares,
subject to the terms and conditions set forth in this Agreement, in order to carry out the purpose of the Barnwell Industries, Inc. Amended and Restated 2018 Equity Incentive Plan (the “Plan”).
All capitalized terms not defined in this Agreement shall have the same meaning as set forth in the Plan. See Section 2 of the Plan for a list of certain defined terms.
In the event of a conflict between the terms of this Agreement, the Award Memorandum and the terms of the Plan, the terms of the
Plan shall govern. In the event of a conflict between the terms of this Agreement and the Award Memorandum, the terms of this Agreement shall govern.
ARTICLE 1.
Grant and Terms of Restricted Stock Units
1.1 Grant of Restricted Stock Units. Pursuant to the Plan, the Company has granted to the Participant the number of Restricted Stock Units as specified in the
Award Memorandum (“Restricted Stock Units”), effective as of the Grant Date.
1.2 Vesting As Condition of Payment. The Restricted Stock Units evidenced by this Agreement and these terms and conditions shall only result in the issuance
of Shares equal in number to the Restricted Stock Units to the extent the Participant is “Vested” in the Restricted Stock Units on the dates the Restricted Stock Units
are to be paid as specified in Section 1.4. The Restricted Stock Units will become Vested as follows:
(a) Employment Through Vesting Periods. The Participant will become Vested in the Restricted Stock Units subject to this award as follows[______________]; provided, that, the
Participant remains in the continuous employ of the Company or a Subsidiary throughout the period beginning on the Grant Date and ending on the applicable Vesting Date, as set forth in the Award Memorandum (“Vesting Periods”).
(b) Death, Disability, Retirement or a Termination Without Cause. If the Participant experiences a termination of employment with the Company because of the Participant’s death,
Disability (as defined herein) or Retirement (as defined herein) or a termination of employment by the Company without Cause (as defined herein) during the applicable Vesting Period, the Participant shall become Vested in all unvested Restricted
Stock Units.
For purposes of this Agreement, “Disability” shall mean a medically
determinable physical or mental impairment that can be expected to result in death or can be expected to last for a continuous period of not less than 12 months and that results in the Participant: (i) being unable to engage in any substantial
gainful activity; or (ii) receiving income replacement benefits for a period of not less than three months under an accident or health plan covering employees of the Company. For purposes of this Agreement, “Retirement” shall mean the Participant’s retirement from active employment with the Company or Subsidiary upon or after the attainment of at least age 65 and at least a 5-year period of service with
the Company and/or Subsidiary.
(c) Change in Control. In the event a Change in Control occurs during the applicable Vesting Period, the Participant will become Vested in the Restricted Stock Units only to the
extent provided in Section 1.3.
In the event the Participant otherwise terminates employment prior to becoming Vested in the Restricted Stock Units or the Participant’s employment is
terminated by the Company for Cause, the Participant shall forfeit all rights to any unvested Restricted Stock Units evidenced by this Agreement.
1.3 Change in Control Vesting.
(a) If the Participant remains in the continuous employ of the Company or a Subsidiary throughout the period beginning on the Grant Date and ending on the date of a Change in Control, the Participant
will become 100% Vested upon the Change in Control in all unvested Restricted Stock Units evidenced by this Agreement, except to the extent that an award meeting the requirements of Section 1.3(d) (a “Replacement Award”) is provided to the Participant in accordance with Section 1.3(d) to replace, adjust or continue the award of unvested Restricted Stock Units covered by this Agreement
(the “Replaced Award”). If a Replacement Award is provided, references to unvested Restricted Stock Units in this Agreement shall be deemed to refer to the Replacement Award after the Change in Control.
(b) If, upon or after
receiving a Replacement Award, the Participant experiences a termination of employment with the Company or a Subsidiary of the Company (or any of their successors) (as applicable, the “Successor”) by reason of the Participant terminating employment for Good Reason or the Successor terminating the Participant’s employment other than for Cause, in each case within a period of two years after the Change in
Control and during the applicable Vesting Period, the Participant shall become 100% Vested in the Replacement Award upon such termination.
(c) If a Replacement
Award is provided, notwithstanding anything in this Agreement to the contrary, any outstanding unvested Restricted Stock Units that at the time of the Change in Control are not subject to a “substantial risk of forfeiture” (within the meaning of
Section 409A of the Code) will be deemed to be Vested at the time of such Change in Control and will be paid as provided for in Section 1.4(c).
(d) For purposes of
this Agreement, a “Replacement Award” means an award: (i) of the same type (e.g., time-based restricted stock units) as the Replaced Award; (ii) that has a value at
least equal to the value of the Replaced Award; (iii) that relates to publicly traded equity securities of the Company or its successor in the Change in Control or another entity that is affiliated with the Company or its successor following the
Change in Control; (iv) if the Participant holding the Replaced Award is subject to U.S. federal income tax under the Code, the tax consequences of which to such Participant under the Code are not less favorable to such Participant than the tax
consequences of the Replaced Award; and (v) the other terms and conditions of which are not less favorable to the Participant holding the Replaced Award than the terms and conditions of the Replaced Award (including the provisions that would
apply in the event of a subsequent Change in Control). A Replacement Award may be granted only to the extent it does not result in the Replaced Award or Replacement Award failing to comply with or be exempt from Section 409A of the Code. Without
limiting the generality of the foregoing, the Replacement Award may take the form of a continuation of the Replaced Award if the requirements of the two preceding sentences are satisfied. The determination of whether the conditions of this
Section 1.3(d) are satisfied will be made by the Committee, as constituted immediately before the Change in Control, in its sole discretion.
(e) For purposes of
this Agreement, a termination for “Cause” shall mean that, prior to termination of employment, the Participant shall have committed: (i) and been convicted of a criminal
violation involving fraud, embezzlement or theft in connection with his or her duties or in the course of his or her employment with the Company or any Affiliate (or the Successor, if applicable); (ii) intentional wrongful damage to property of
the Company or any Affiliate (or the Successor, if applicable); (iii) intentional wrongful disclosure of secret processes or confidential information of the Company or any Affiliate (or the Successor, if applicable); or (iv) intentional wrongful
engagement in any competitive activity; and any such act shall have been demonstrably and materially harmful to the Company or any Affiliate (or the Successor, if applicable). For purposes of this Agreement, no act or failure to act on the part
of the Participant shall be deemed “intentional” if it was due primarily to an error in judgment or negligence, but shall be deemed “intentional” only if done or omitted to be done by the Participant not in good faith and without reasonable
belief that the Participant’s action or omission was in the best interest of the Company or an Affiliate (or the Successor, if applicable).
(f) A termination “for Good Reason” shall mean the Participant’s termination of employment with the Successor as a result of the initial occurrence, without the Participant’s consent, of one
or more of the following events:
(i) a material
diminution in the Participant’s annual base salary rate as in effect from time to time (“Base Pay”);
(ii) a material
diminution in the Participant’s authority, duties or responsibilities;
(iii) a material change
in the geographic location at which the Participant must perform services;
(iv) a reduction in the
Participant’s opportunity regarding annual bonus, incentive or other payment of compensation, in addition to Base Pay, made or to be made in regard to services rendered in any year or other period pursuant to any bonus, incentive, profit-sharing,
performance, discretionary pay or similar agreement, policy, plan, program or arrangement (whether or not funded) of the Successor; and
(v) any other action
or inaction that constitutes a material breach by the Participant’s employer of the employment agreement, if any, under which the Participant provides services.
Notwithstanding the foregoing, “Good Reason” shall not be deemed to exist unless: (A) the Participant has provided notice to his or her employer of the
existence of one or more of the conditions listed in (i) through (v) above within 90 days after the initial occurrence of such condition or conditions; and (B) such condition or conditions have not been cured by the Participant’s employer within 30
days after receipt of such notice.
1.4 Payment of Restricted Stock Units.
(a) Payment After the Vesting Period. Subject to Sections 1.4(b) and (c), the Restricted Stock Units that are Vested as of the Vesting Date shall be paid after the end of the
applicable Vesting Period, but in any event no later than 2-½ months after the end of the applicable Vesting Period to the extent they have not been previously paid to the Participant.
(b) Payment After Death, Disability, Retirement or a Termination Without Cause. Notwithstanding Section 1.4(a), if the Participant experiences a termination of employment with
the Company because of the Participant’s death, Disability or Retirement or termination of employment by the Company without Cause or by the Participant for Good Reason during the applicable Vesting Period, the Vested Restricted Stock Units will
be paid within 30 days following the date of such termination. Any payment of Restricted Stock Units to a deceased Participant shall be paid to the Death Beneficiary. “Death Beneficiary” shall mean the person the Participant designates in
accordance with the Company's procedures, and if the Participant does not identify a person, the “Death Beneficiary” shall be the estate of the Participant..
(c) Change in Control. Notwithstanding Section 1.4(a) and Section 1.4(b), to the extent any Restricted Stock Units are Vested as of a Change in Control, such Vested Restricted
Stock Units will be paid within 10 days of the Change in Control; provided, however, that
if such Change in Control would not qualify as a permissible date of distribution under Section 409A(a)(2)(A) of the Code, and the regulations thereunder, and where Section 409A of the Code applies to such distribution, payment will be made on
the date that would have otherwise applied pursuant to this Section 1.4.
(d) Payment Following a Change in Control. Notwithstanding Section 1.2 and Section 1.4(a), if, during the two-year period following a Change in Control, the Participant
experiences a qualifying termination of employment (as described in Section 1.3(b)), the Restricted Stock Units that are Vested as of the date of such termination of employment shall be paid within 30 days of such termination of employment to the
extent they have not been previously paid to the Participant; provided, however, that if
such Change in Control would not qualify as a permissible date of distribution under Section 409A(a)(2)(A) of the Code, and the regulations thereunder, and where Section 409A of the Code applies to such distribution, payment will be made on the
date that would have otherwise applied pursuant to this Section 1.4.
(e) General. The Restricted Stock Units are to be settled in Shares. The Committee shall withhold Shares to the extent necessary to satisfy income tax, social insurance, payroll
tax, fringe benefits tax, payment on account or other tax-related item withholding requirements, as described in Section 4.2
(f) Payment Obligation. Prior to payment, the Company shall only have an unfunded and unsecured obligation to make payment of Restricted Stock Units to the Participant. The
Restricted Stock Units evidenced by this Agreement that have not yet been earned, and any interests of the Participant with respect thereto, are not transferable other than pursuant to the laws of descent and distribution, or in accordance with
Section 1.4(b).
(g) No Shareholder Rights. The Participant shall have no rights of ownership in the Shares underlying the Restricted Stock Units and no right to vote the Shares underlying the
Restricted Stock Units until the date on which the Shares underlying the Restricted Stock Units are issued or transferred to the Participant pursuant to this Section 1.4.
ARTICLE 2.
Other Terms
2.1 Limitations Applicable to Section 16 Persons. Notwithstanding any other provision of
the Plan or this Agreement, the Plan, the Restricted Stock Units and this Agreement shall be subject to any additional limitations set forth in any applicable exemptive rule under Section 16 of the Exchange Act (including any amendment to Rule
16b-3 of the Exchange Act) that are requirements for the application of such exemptive rule. To the extent permitted by applicable law, this Agreement shall be deemed amended to the extent necessary to conform to such applicable exemptive rule.
ARTICLE 3.
Acknowledgments
3.1 Acknowledgments. In
accepting the award, the Participant acknowledges, understands and agrees to the following:
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(a) |
The Plan is established voluntarily by the Company, it is discretionary in nature and it may be modified, amended, suspended or terminated by the Company at any
time, to the extent permitted by the Plan;
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(b) |
The grant of the Restricted Stock Units is voluntary and occasional and does not create any contractual or other right to receive future grants of Restricted
Stock Units, or benefits in lieu of Restricted Stock Units, even if Restricted Stock Units have been granted in the past;
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(c) |
All decisions with respect to future Restricted Stock Units or other grants, if any, will be at the sole discretion of the Company;
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(d) |
The Participant’s participation in the Plan is voluntary;
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(e) |
The Restricted Stock Unit Award and the Participant’s participation in the Plan shall not create a right to employment or be interpreted as forming an employment
or services contract with the Company or any Subsidiary and shall not interfere with the ability of the Company, or any Subsidiary, as applicable, to terminate the Participant’s employment or service relationship (if any);
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(f) |
The future value of the underlying Shares is unknown, indeterminable and cannot be predicted with certainty;
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(g) |
No claim or entitlement to compensation or damages shall arise from forfeiture of any Restricted
Stock Units resulting from the Participant ceasing to provide employment or other services to the Company or a Subsidiary (for any reason whatsoever whether or not later found to be invalid or in breach of employment laws in the
jurisdiction where the Participant is employed or the terms of the Participant’s employment agreement, if any), and in consideration of the grant of the Restricted Stock Units to which the Participant is otherwise not entitled, the
Participant irrevocably agrees never to institute any claim against the Company or any of its Subsidiaries, and the Participant waives his or her ability, if any, to bring any such claim, and releases the Company and its Subsidiaries
from any such claim; if, notwithstanding the foregoing, any such
claim is allowed by a court of competent jurisdiction, then, by participating in the Plan, the Participant shall be deemed irrevocably to have agreed not to pursue such claim and agrees to execute any and all documents necessary to
request dismissal or withdrawal of such claim;
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Neither the Plan nor the Restricted Stock Units shall be construed to create an employment relationship where any employment relationship did not otherwise
already exist;
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(i) |
The Company is not providing any tax, legal or financial advice, nor is the Company making any recommendations regarding the Participant’s participation in the
Plan, or the Participant’s acquisition or sale of the underlying Shares. The Participant is hereby advised to consult with his or her own personal tax, legal and financial advisors regarding his or her participation in the Plan before
taking any action related to the Restricted Stock Units;
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The Restricted Stock Units and the Shares subject to the Restricted Stock Units, and the income and value of same, are not part of normal or expected compensation
for purposes of calculating any severance, resignation, termination, redundancy, dismissal, end-of-service payments, bonuses, long-service awards, pension or retirement or welfare benefits or similar payments; and
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(k) |
The Company reserves the right to impose other requirements on participation in the Restricted Stock Units and on any Shares acquired under the Plan, to the
extent the Company determines it is necessary or advisable in order to comply with law or other applicable rules or facilitate the administration of the Plan, and to require the Participant to sign any additional agreements or
undertakings that may be necessary to accomplish the foregoing.
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Notwithstanding anything in this Agreement to the contrary, the Participant acknowledges and agrees that this Restricted Stock Unit Award, this Agreement and any related benefits
or compensation under this Agreement are subject to the terms and conditions of the Company’s clawback policy (if any) as may be in effect from time to time including specifically to implement Section 10D of the Exchange Act and any
applicable rules or regulations promulgated thereunder (including applicable rules and regulations of any national securities exchange on which the Shares may be traded) (the “Compensation Recovery Policy”), and that applicable provisions
of this Agreement shall be deemed superseded by and subject to the terms and conditions of the Compensation Recovery Policy from and after the effective date thereof.
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ARTICLE 4.
General Provisions
4.1 Compliance with Law. The Company shall make reasonable efforts to comply with all applicable federal and state securities laws; provided, however, notwithstanding any other provision of the Agreement and these terms and conditions, the
Company shall not be obligated to issue any Shares pursuant to the Agreement and these terms and conditions if the issuance or payment thereof would result in a violation of any such law; provided further, however, that the Shares will be issued at the earliest date at which the Company reasonably anticipates that the issuance of
the Shares will not cause such violation. Notwithstanding anything in this Agreement to the contrary, nothing in this Agreement prevents the Participant from providing, without prior notice to the Company, information to governmental authorities
regarding possible legal violations or otherwise testifying or participating in any investigation or proceeding by any governmental authorities regarding possible legal violations, and for purpose of clarity the Participant is not prohibited from
providing information voluntarily to the Securities and Exchange Commission pursuant to Section 21F of the Exchange Act.
4.2 Withholding Taxes. To the extent that the Company is required to withhold federal, state, local or foreign taxes or other amounts in connection with any
payment made or benefit realized by the Participant under this Agreement, the Company shall withhold Shares having a value equal to the amount required to be withheld. The Shares used for tax or other withholding will be valued at an amount equal
to the fair market value of such Shares on the date the benefit is to be included in the Participant’s income. In no event will the fair market value of the Shares to be withheld and delivered pursuant to this Section exceed the maximum amount of
taxes that could be required to be withheld.
4.3 Continuous Employment. For purposes of this Agreement, the continuous employment of the Participant with the Company shall not be deemed to have been
interrupted, and the Participant shall not be deemed to have separated from service with the Company, by reason of the transfer of his employment among the Company or Subsidiaries or an approved leave of absence, unless otherwise indicated in the
Plan or if required to comply with Section 409A of the Code.
4.4 Relation to Other Benefits. Any economic or other benefit to the Participant under the Agreement and these terms and conditions or the Plan shall not be
taken into account in determining any benefits to which the Participant may be entitled under any profit-sharing, retirement or other benefit or compensation plan maintained by the Company or a Subsidiary and shall not affect the amount of any
life insurance coverage available to any beneficiary under any life insurance plan covering employees of the Company or Subsidiary.
4.5 Adjustments. Restricted Stock Units evidenced by this Agreement are subject to mandatory adjustment as provided in Section 8 of the Plan.
4.6 These Terms and Conditions Subject to Plan. The Restricted Stock Units covered under the Agreement and all of the terms and conditions hereof are subject
to all of the terms and conditions of the Plan, a copy of which is available upon request.
4.7 Transferability. Except as otherwise provided in the Plan, the Restricted Stock Units are non-transferable and any attempts to assign, pledge, hypothecate
or otherwise alienate or encumber (whether by law or otherwise) any Restricted Stock Units shall be null and void.
4.8 Data Privacy. The Participant hereby explicitly and unambiguously consents to the collection, use and transfer, in electronic or other form, of the
Participant’s personal data as described in this Agreement and any other Restricted Stock Unit award materials by and among, as applicable, the Company or Subsidiaries for the exclusive purpose of implementing, administering and managing the
Participant’s participation in the Plan.
The Participant understands that the Company or Subsidiary may hold certain personal information about the Participant, including,
but not limited to, the Participant’s name, home address and telephone number, date of birth, social security number or other identification number, salary, nationality, job title, any Shares of or directorships in the Company that are held,
details of all Restricted Stock Units or any other entitlement to Shares awarded, canceled, exercised, vested, unvested or outstanding in the Participant’s favor, for the exclusive purpose of implementing, administering and managing the Plan (“Data”).
The Participant understands that Data will be transferred to the Company’s broker, or such other stock plan service provider as may
be selected by the Company in the future, which is assisting the Company with the implementation, administration and management of the Plan. The Participant understands that the recipients’ use of the Data may be located in the United States or
elsewhere, and that the recipients’ country (e.g., the United States) may have different data privacy laws and protections than the Participant’s country. The Participant understands that if he or she resides outside the United States, he or she
may request a list with the names and addresses of any potential recipients of the Data by contacting his or her local human resources representative. The Participant authorizes the Company, the Company’s broker and any other possible recipients
which may assist the Company (presently or in the future) with implementing, administering and managing the Plan to receive, possess, use, retain and transfer the Data, in electronic or other form, for the sole purpose of implementing,
administering and managing the Participants’ participation in the Plan. The Participant understands that Data will be held only as long as is necessary to implement, administer and manage the Participant’s participation in the Plan. The Participant
understands if he or she resides outside the United States, he or she may, at any time, view their respective Data, request additional information about the storage and processing of their Data, require any necessary amendments to their Data or
refuse or withdraw the consents herein, in any case without cost, by contacting in writing his or her local human resources representative. Further, the Participant understands that he or she is providing the consents herein on a purely voluntary
basis. If the Participant does not consent, or if the Participant later seeks to revoke his or her consent, his or her employment status or service and career with the Employer will not be adversely affected; the only adverse consequence of
refusing or withdrawing the Participant’s consent is that the Company would not be able to grant Restricted Stock Units or other equity awards or administer or maintain such awards. Therefore, the Participant understands that refusing or
withdrawing his or her consent may affect the Participant’s ability to participate in the Plan. For more information on the consequences of the Participant’s refusal to consent or withdrawal of consent, the Participant understands that he or she
may contact his or her local human resources representative.
4.9 Amendments. This Agreement can be amended at any time by the Committee. Any amendment to the Plan shall be deemed to be an amendment to this Agreement to
the extent that the amendment is applicable hereto. Except for amendments necessary to bring this Agreement into compliance with current law including Section 409A of the Code, no amendment to this Agreement shall materially and adversely affect
the rights of the Participant without the Participant’s written consent.
4.10 Severability. The provisions of this Agreement are severable and if any one or more provisions are determined to be invalid or otherwise unenforceable, in
whole or in part, the remaining provisions shall nevertheless be binding and enforceable.
4.11 Electronic Delivery. The Company may, in its sole discretion, decide to deliver any documents related to the Restricted Stock Units by electronic means.
By accepting this award of Restricted Stock Units, the Participant hereby consents to receive such documents by electronic delivery and agrees to participate in the Plan through an on-line or electronic system established and maintained by the
Company or a third party designated by the Company.
4.12 Headings. Headings are given to the articles or sections of this Agreement solely as a convenience to facilitate reference. Such headings shall not be
deemed in any way material or relevant to the construction or interpretation of this Agreement or any provision hereof.
4.13 Governing Law/Venue. The internal substantive laws of the State of Delaware shall govern the interpretation, validity, administration, enforcement and
performance of the terms of this Agreement regardless of the law that might be applied under principles of conflicts of laws. For purposes of litigating any dispute that arises directly or indirectly from the relationship of the parties
evidenced by this award of Restricted Stock Units or this Agreement, the parties hereby submit to and consent to the exclusive jurisdiction of the State of Hawaii and agree that such litigation shall be conducted only in the courts of Honolulu
County, Hawaii, or the federal courts for the United States for the District of Hawaii and no other courts, where this grant is made and/or to be performed.
4.14 Section 409A of the Code. To the extent applicable, it is intended that this Agreement and the Plan comply with the provisions of Section 409A of the
Code. This Agreement and the Plan shall be administered in a manner consistent with this intent, and any provision that would cause the Agreement or the Plan to fail to satisfy Section 409A of the Code shall have no force and effect until amended
to comply with Section 409A of the Code (which amendment may be retroactive to the extent permitted by Section 409A of the Code and may be made by the Company without the consent of the Participant). The terms “termination of employment,” “terminates employment,” and similar words and phrases used in this Agreement mean a
“separation from service” within the meaning of Treasury Regulation section 1.409A-1(h). If, at the time of the Participant’s separation from service (within the meaning of Section 409A of the Code), (a) the Participant will be a specified
employee (within the meaning of Section 409A of the Code and using the identification methodology selected by the Company from time to time) and (b) the Company makes a good faith determination that an amount payable hereunder constitutes
deferred compensation (within the meaning of Section 409A of the Code) the payment of which is required to be delayed pursuant to the six-month delay rule set forth in Section 409A of the Code in order to avoid taxes or penalties under Section
409A of the Code, then the Company will not pay such amount on the otherwise scheduled payment date but will instead pay it, without interest, on the fifth business day of the seventh month after such separation from service.
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BARNWELL INDUSTRIES, INC.
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Signed Electronically
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By:
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Name:
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[_____]
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Title:
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[_______]
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Exhibit A
Acceptance by the Participant
By signing below, the Participant acknowledges acceptance of, and consents to be bound by, the Plan and this Agreement and any other
rules, agreements or other terms and conditions incorporated herein by reference.
IF I FAIL TO ACKNOWLEDGE ACCEPTANCE OF THE AWARD WITHIN NINETY (90) DAYS OF THE GRANT DATE SET FORTH IN THE AGREEMENT, THE COMPANY
MAY DETERMINE THAT THIS AWARD HAS BEEN FORFEITED.
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Participant:
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[_________]
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Date
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