Exhibit 10.1


 


 


November 17, 2015


 


 


FIRST AMENDMENT TO PROMISSORY NOTE


 


This First Amendment to Promissory Note (this “First
Amendment”) is effective as of November 10, 2015 (the “First Amendment Effective Date”), by and
between Vaccinogen, Inc., a Maryland corporation (the “Borrower”) and Dolphin Offshore Partners, LP, a limited
partnership formed under the laws of Delaware (the “Lender”).


 


RECITALS


 


WHEREAS, the Borrower and the Lender entered
into that certain unsecured promissory note dated as of August 12, 2015 (the “Promissory Note”), pursuant to
which the Lender agreed to lend, and the Borrower agreed to borrow, a loan with a principal amount of $800,000; and


 


WHEREAS, the Borrower and the Lender desire
to enter into this First Amendment to amend the term of the Promissory Note and add to the Promissory Note certain provisions that
would convert the outstanding principal amount and unpaid interest under the Promissory Note to shares of the Borrower’s
common stock upon the satisfaction of certain conditions;


 


NOW THERFORE, in consideration of the mutual
covenants, agreements, representations and warranties set forth herein, the parties hereby agree as follows:


 


Agreement


 


1.Capitalized terms used
but not otherwise defined herein shall have the meanings ascribed thereto in the Promissory Note.


 


2.Paragraph 3 (“Maturity”)
of the Promissory Note shall be deleted in its entirety and replaced with the following:


 


“Maturity. The entire Principal Amount
and all accrued interest shall become fully due and payable on March 31, 2016 (the “Maturity Date”); provided
that, at any time before the Maturity Date, the Lender may elect to convert part or all of the outstanding principal and any
interest due and payable under the Promissory Note at such time into shares of the Company’s common stock, par value $0.0001
per share (the “Common Stock”), at a rate of $2.50 per share by providing written notice to the Borrower of
such election. Upon receipt of such written notice, the Borrower shall issue the corresponding whole number of shares to the Lender
within a commercially reasonable period of time. For the avoidance of doubt, an issuance of the Common Stock pursuant to clause
(ii) of the preceding sentence shall not constitute a default under this Note.”


 






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3.Paragraph 5 (“Payments”)
of the Promissory Note shall be deleted in its entirety and replaced with the following:


 


Payments. Except as otherwise stated in Paragraph
3 hereof, all payments made hereunder shall be in lawful money of the United States of America. All payments and prepayments shall
be applied first to costs of collection, next, to accrued interest, and thereafter to principal.


 


4.The Lender acknowledges
and agrees that the Borrower’s obligation to issue the Common Stock pursuant to Paragraph 2 above is conditioned upon the
Borrower and the Lender entering into a mutually agreed subscription agreement prior to such issuance, which agreement will be
substantially in the form set forth in Annex A hereto.


 


5.For the avoidance of doubt,
the right to receive the Common Stock described in Paragraph 2 above shall not be assignable by the Lender without the prior written
consent of the Borrower.


 


6.Except as expressly modified
by this First Amendment, all other provisions of the Promissory Note are unmodified and continue in full force and effect.


 


7.In the event of any conflict
between this First Amendment and the Promissory Note, the provisions of this First Amendment shall prevail.


 


8.This First Amendment may
be executed in multiple originals, each of which is deemed to be an original, and may be signed in counterparts.


  


 


 


 


 


[Remainder of page intentionally left
blank]


 


 




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IN WITNESS WHEREOF, the Borrower and the Lender have caused
this First Amendment to be executed by duly authorized officers on November 17, 2015.


 


Borrower:


 





	VACCINOGEN, INC.
	 	 
	 	 
	Name: Andrew L. Tussing
	Title: Chairman and Chief Executive Officer
	 	 
	 	 
	DOLPHIN OFFSHORE PARTNERS
	 	 
	 	 
	Name:	 
	Title:	 







 





 




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ANNEX A


 


Subscription Agreement


 


THE SECURITIES HAVE
NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933 OR THE SECURITIES LAWS OF ANY STATE OR ANY OTHER JURISDICTION. THERE ARE FURTHER
RESTRICTIONS ON THE TRANSFERABILITY OF THE SECURITIES DESCRIBED HEREIN.


 


THE PURCHASE OF THE
SECURITIES INVOLVES A HIGH DEGREE OF RISK AND SHOULD BE CONSIDERED ONLY BY PERSONS WHO CAN BEAR THE RISK OF THE LOSS OF THEIR ENTIRE
INVESTMENT.


 


Ladies and Gentlemen:


 


The undersigned understands
that VACCINOGEN, INC., a corporation organized under the laws of Maryland (the “Company”), is offering shares
of its common stock, par value $0.0001 per share in a private placement. The undersigned further understands that the offering
is being made without registration of the Securities under the Securities Act of 1933, as amended (the “Securities Act”),
or any securities law of any state of the United States or of any other jurisdiction, and is being made only to “Accredited
Investors” (as defined in Rule 501 of Regulation D under the Securities Act).


 


1.Subscription.
Subject to the terms and conditions of this Subscription Agreement (this “Subscription Agreement”), on the date of
the Closing referred to in Section 3 hereof, the undersigned shall purchase from the Company and the Company shall sell
to the undersigned [ ] shares of common stock, par value $0.0001 per share (the “Securities”), for the aggregate purchase
price of [$ ], at [$ ] per share.


 


2.Acceptance of
Subscription and Issuance of Securities. Notwithstanding anything in this Subscription Agreement to the contrary, the Company
shall have no obligation to issue any of the Securities to any person who is a resident of a jurisdiction in which the issuance
of the Securities to such person would constitute a violation of the securities, “blue sky” or other similar laws of
such jurisdiction (collectively referred to as the “State Securities Laws”).


 


3.The Closing.
The closing of the purchase and sale of the Securities (the “Closing”) shall take place at the offices of the
Company on the date the Company countersigns this Subscription Agreement, or at such other time and place as the Company may designate.


 


4.Payment for
Securities. Consideration for the issuance of the Securities having already been received by the Company, the Company shall
deliver certificates or other appropriate evidence of the Securities to the undersigned at the Closing bearing an appropriate legend
referring to the fact that the Securities were sold in reliance upon an exemption from registration under the Securities Act.


 






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5.Representations
and Warranties of the Company. As of the Closing, the Company represents and warrants that the Company is duly formed and validly
existing under the laws of Maryland, with full power and authority to conduct its business as it is currently being conducted and
to own its assets; and has secured any other authorizations, approvals, permits and orders required by law for the conduct by the
Company of its business as it is currently being conducted.


 


6.Representations
and Warranties of the Undersigned. The undersigned hereby represents and warrants to and covenants with the Company that:


 


(a)General.


 


(i)The undersigned
has all requisite authority to receive the Securities, enter into this Subscription Agreement and to perform all the obligations
required to be performed by the undersigned hereunder, and such purchase will not contravene any law, rule or regulation binding
on the undersigned or any investment guideline or restriction applicable to the undersigned.


 


(ii)The undersigned
is a resident of the state set forth on the signature page hereto and is not acquiring the Securities as a nominee or agent or
otherwise for any other person.


 


(iii)The undersigned
will comply with all applicable laws and regulations in effect in any jurisdiction in which the undersigned purchases or sells
the Securities and obtain any consent, approval or permission required for such purchases or sales under the laws and regulations
of any jurisdiction to which the undersigned is subject or in which the undersigned makes such purchases or sales, and the Company
shall have no responsibility therefor.


 


(b)Information
Concerning the Company.


 


(i)The undersigned
has been given the opportunity to ask questions and receive answers concerning the terms and conditions of the issuance of the
Securities. The undersigned has been given the opportunity to obtain material and relevant information from the Company enabling
it to make an informed investment decision. All data that the undersigned has requested has been furnished to it. The undersigned
is aware of and has access to the Company’s public filings with the Securities and Exchange Commission (the “Public
Filings”).


 


(ii)The undersigned
understands and accepts that the purchase of the Securities involves various risks, including the risks outlined in this Subscription
Agreement and the Public Filings. The undersigned represents that it is able to bear any loss associated with an investment in
the Securities.


 


(iii)The undersigned
confirms that it is not relying on any communication (written or oral) of the Company or any of its affiliates, as investment advice
or as a recommendation to purchase the Securities. It is understood that information and explanations related to the terms and
conditions of the Securities provided by the Company or any of its affiliates shall not be considered investment advice or a recommendation
to purchase the Securities, and that neither the Company nor any of its affiliates is acting or has acted as an advisor to the
undersigned in deciding to invest in the Securities. The undersigned acknowledges that neither the Company nor any of its affiliates
has made any representation regarding the proper characterization of the Securities for purposes of determining the undersigned’s
authority to invest in the Securities.


 






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(iv)The undersigned
is familiar with the business and financial condition and operations of the Company. The undersigned has had access to such information
concerning the Company and the Securities as it deems necessary to enable it to make an informed investment decision concerning
the purchase of the Securities.


(v)The undersigned
understands that, unless the undersigned notifies the Company in writing to the contrary at or before the Closing, each of the
undersigned’s representations and warranties contained in this Subscription Agreement will be deemed to have been reaffirmed
and confirmed as of the Closing, taking into account all information received by the undersigned.


 


(vi)The undersigned
understands that no federal or state agency has passed upon the merits or risks of an investment in the Securities or made any
finding or determination concerning the fairness or advisability of this investment.


 


(c)Non-reliance.


 


(i)The undersigned
represents that it is not relying on (and will not at any time rely on) any communication (written or oral) of the Company, as
investment advice or as a recommendation to purchase the Securities, it being understood that information and explanations related
to the terms and conditions of the Securities shall not be considered investment advice or a recommendation to purchase the Securities.


 


(ii)The undersigned
confirms that the Company has not (A) given any guarantee or representation as to the potential success, return, effect or benefit
(either legal, regulatory, tax, financial, accounting or otherwise) of an investment in the Securities or (B) made any representation
to the undersigned regarding the legality of an investment in the Securities under applicable legal investment or similar laws
or regulations. In deciding to purchase the Securities, the undersigned is not relying on the advice or recommendations of the
Company and the undersigned has made its own independent decision that the investment in the Securities is suitable and appropriate
for the undersigned.


 


(d)Status of
Undersigned.


 


(i)The undersigned
has such knowledge, skill and experience in business, financial and investment matters that the undersigned is capable of evaluating
the merits and risks of an investment in the Securities. With the assistance of the undersigned’s own professional advisors,
to the extent that the undersigned has deemed appropriate, the undersigned has made its own legal, tax, accounting and financial
evaluation of the merits and risks of an investment in the Securities and the consequences of this Subscription Agreement. The
undersigned has considered the suitability of the Securities as an investment in light of its own circumstances and financial condition
and the undersigned is able to bear the risks associated with an investment in the Securities and its authority to invest in the
Securities.


 






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(ii)The undersigned
is an “accredited investor” as defined in Rule 501(a) under the Securities Act. The undersigned agrees to furnish any
additional information requested by the Company or any of its affiliates to assure compliance with applicable U.S. federal and
state securities laws in connection with the purchase and sale of the Securities. The undersigned acknowledges that the undersigned
has completed the Investor Questionnaire contained in Appendix A (the “Questionnaire”) and that the information
and representations contained therein is complete and accurate as of the date thereof and is hereby affirmed as of the date hereof
and as of the Closing. Any information that has been furnished or that will be furnished by the undersigned to evidence its status
as an accredited investor is accurate and complete, and does not contain any misrepresentation or material omission.


 


(e)Restrictions
on Transfer or Sale of Securities.


 


(i)The undersigned
is acquiring the Securities solely for the undersigned’s own beneficial account, for investment purposes, and not with a
view to, or for resale in connection with, any distribution of the Securities. The undersigned understands that the Securities
have not been registered under the Securities Act or any State Securities Laws by reason of specific exemptions under the provisions
thereof which depend in part upon the investment intent of the undersigned and of the other representations made by the undersigned
in this Subscription Agreement and the Questionnaire. The undersigned understands that the Company is relying upon the representations
and agreements contained in this Subscription Agreement and the Questionnaire (and any supplemental information) for the purpose
of determining whether this transaction meets the requirements for such exemptions.


 


(ii)The undersigned
understands that the Securities are “restricted securities” under applicable federal securities laws and that the Securities
Act and the rules of the U.S. Securities and Exchange Commission (the “Commission”) provide in substance that
the undersigned may dispose of the Securities only pursuant to an effective registration statement under the Securities Act or
an exemption therefrom, and the undersigned understands that the Company has no obligation or intention to register any of the
Securities, or to take action so as to permit sales pursuant to the Securities Act (including Rule 144 thereunder). Consequently,
the undersigned understands that the undersigned must bear the economic risks of the investment in the Securities for an indefinite
period of time.


 


(iii)The undersigned
agrees: (A) that the undersigned will not sell, assign, pledge, give, transfer or otherwise dispose of the Securities or any interest
therein, or make any offer or attempt to do any of the foregoing, except pursuant to a registration of the Securities under the
Securities Act and all applicable State Securities Laws, or in a transaction which is exempt from the registration provisions of
the Securities Act and all applicable State Securities Laws; (B) that the certificates or book entries representing the Securities
will bear a legend making reference to the foregoing restrictions; and (C) that the Company and its affiliates shall not be required
to give effect to any purported transfer of such Securities except upon compliance with the foregoing restrictions.


 






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(iv)The undersigned
acknowledges that neither the Company nor any other person offered to sell the Securities to it by means of any form of general
solicitation or advertising, including but not limited to: (A) any advertisement, article, notice or other communication published
in any newspaper, magazine or similar media or broadcast over television or radio or (B) any seminar or meeting whose attendees
were invited by any general solicitation or general advertising.


 


7.Conditions to
Obligations of the Undersigned and the Company. The obligations of the undersigned to purchase and pay for the Securities specified
in Section 1 and of the Company to sell the Securities are subject to the satisfaction at or prior to the Closing of the
following conditions precedent: the representations and warranties of the Company contained in Section 5 hereof and of the
undersigned contained in Section 6 hereof shall be true and correct as of the Closing in all respects with the same effect
as though such representations and warranties had been made as of the Closing.


 


8.Obligations
Irrevocable. The obligations of the undersigned shall be irrevocable.


 


9.Legend.
Any certificates representing the Securities sold pursuant to this Subscription Agreement will be imprinted with a legend in substantially
the following form:


 


“THE SECURITIES
EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”),
OR THE SECURITIES LAWS OF ANY STATE OR OTHER JURISDICTION. THE SECURITIES MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED
EXCEPT (1) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OR (2) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT
UNDER THE SECURITIES ACT, IN EACH CASE IN ACCORDANCE WITH ALL APPLICABLE STATE SECURITIES LAWS AND THE SECURITIES LAWS OF OTHER
JURISDICTIONS, AND IN THE CASE OF A TRANSACTION EXEMPT FROM REGISTRATION, UNLESS THE COMPANY HAS RECEIVED AN OPINION OF COUNSEL
REASONABLY SATISFACTORY TO IT THAT SUCH TRANSACTION DOES NOT REQUIRE REGISTRATION UNDER THE SECURITIES ACT AND SUCH OTHER APPLICABLE
LAWS.”


 


10.Waiver, Amendment.
Neither this Subscription Agreement nor any provisions hereof shall be modified, changed, discharged or terminated except by an
instrument in writing, signed by the party against whom any waiver, change, discharge or termination is sought.


 






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11.Assignability.
Neither this Subscription Agreement nor any right, remedy, obligation or liability arising hereunder or by reason hereof shall
be assignable by either the Company or the undersigned without the prior written consent of the other party.


 


12.Waiver of Jury
Trial. THE UNDERSIGNED IRREVOCABLY WAIVES ANY AND ALL RIGHT TO TRIAL BY JURY WITH RESPECT TO ANY LEGAL PROCEEDING ARISING OUT
OF THE TRANSACTIONS CONTEMPLATED BY THIS SUBSCRIPTION AGREEMENT. Each party to this Subscription
Agreement certifies and acknowledges that (a) no representatives of any other party has represented, expressly or otherwise, that
such other party would not seek to enforce the foregoing waiver in the event of a legal action; (b) such party has considered the
implications of this waiver; (c) such party makes this waiver voluntarily; and (d) such party has been induced to enter into this
Subscription Agreement by, among other things, the mutual waivers and certifications in this section.


 


13.Submission
to Jurisdiction. With respect to any suit, action or proceeding relating to any offers, purchases or sales of the Securities
by the undersigned (“Proceedings”), the undersigned irrevocably submits to the jurisdiction of the federal or
state courts located in the State of Maryland, which submission shall be exclusive unless none of such courts has lawful jurisdiction
over such Proceedings.


 


14.Governing Law.
This Subscription Agreement shall be governed by and construed in accordance with the laws of the State of Maryland.


 


15.Section and
Other Headings. The section and other headings contained in this Subscription Agreement are for reference purposes only and
shall not affect the meaning or interpretation of this Subscription Agreement.


 


16.Counterparts.
This Subscription Agreement may be executed in any number of counterparts, each of which when so executed and delivered shall be
deemed to be an original and all of which together shall be deemed to be one and the same agreement.


 


17.Notices.
All notices and other communications provided for herein shall be in writing and shall be deemed to have been duly given if delivered
personally or sent by registered or certified mail, return receipt requested, postage prepaid to the following addresses (or such
other address as either party shall have specified by notice in writing to the other): 


 


	If to the Company:	
        Vaccinogen, Inc.

         

        949 Fell Street

         

        Baltimore, MD 21231

         

        Attention:Chief Executive Officer

         




 






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	with a copy to:	
        Venable LLP

         

        750 E. Pratt Street, Suite 900

         

        Baltimore, MD 21202

         

        Attention:Eric R. Smith, Esq.

         

	If to the Purchaser:	
        Dolphin Offshore Partners, L.P.

         

        PO Box 16867

         

        Fernandina Beach, FL 32035 



 


18.Binding Effect.
The provisions of this Subscription Agreement shall be binding upon and accrue to the benefit of the parties hereto and their respective
heirs, legal representatives, successors and assigns.


 


19.Survival.
All representations, warranties and covenants contained in this Subscription Agreement shall survive (i) the acceptance of the
subscription by the Company and the Closing, and (ii) the death, disability, or dissolution of the undersigned.


 


20.Notification
of Changes. The undersigned hereby covenants and agrees to notify the Company upon the occurrence of any event prior to the
closing of the purchase of the Securities pursuant to this Subscription Agreement, which would cause any representation, warranty,
or covenant of the undersigned contained in this Subscription Agreement to be false or incorrect.


 


21.Severability.
If any term or provision of this Agreement is invalid, illegal or unenforceable in any jurisdiction, such invalidity, illegality
or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term
or provision in any other jurisdiction.


 


 


 


[SIGNATURE PAGE FOLLOWS]


 




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IN WITNESS
WHEREOF, the undersigned has executed this Subscription Agreement this ____ of ______________________, 2015


 





	 	PURCHASER (if an individual):
	 	 
	 	By:	
	 	Name:	 







 





The offer
to purchase Securities as set forth above is confirmed and accepted by the Company as to [
] shares of common stock.


 





	 	Vaccinogen, Inc.
	 	 
	 	By:	 
	 	 	Name:	Andrew L. Tussing
	 	 	Title: 	Chief Executive Officer







 









 






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APPENDIX A


 


INVESTOR QUESTIONNAIRE


 


This Questionnaire
is being distributed to the undersigned investor (the “Investor”) by Vaccinogen, Inc., a Maryland corporation (the
“Issuer”) in connection with the Subscription Agreement of the Investor to which this Questionnaire is a part (the
“Subscription Agreement”), to enable the Issuer to determine whether the Investor is qualified to invest in the Securities
(as defined in the Subscription Agreement). To be qualified to invest in the Securities, the Investor must be an “Accredited
Investor” (as that term is defined in Rule 501(a) of Regulation D promulgated under Section 4(a)(2) of the Securities Act
of 1933, as amended (the “Securities Act”)).


 


The Issuer will rely
upon the accuracy and completeness of the information provided in this Questionnaire in establishing that the issuance of the Securities
is exempt from the registration requirements of the Securities Act.


 


ACCORDINGLY, THE
INVESTOR IS OBLIGATED TO READ THIS QUESTIONNAIRE CAREFULLY AND TO ANSWER THE ITEMS CONTAINED HEREIN COMPLETELY AND ACCURATELY.


 


ALL INFORMATION CONTAINED
IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY. However, the Investor understands and agrees that the Issuer may present,
upon giving prior notice to the Investor, this Questionnaire to such parties as the Issuer deems appropriate if called upon to
establish that the issuance of the Securities (i) is exempt from the registration requirements of the Securities Act or (ii) meets
the requirements of applicable state securities laws; provided, however, that the Issuer need not give prior notice to the
Investor of its presentation of this Questionnaire to the Issuer’s regularly employed legal, accounting and financial advisors.


 


The Investor understands
that this Questionnaire is merely a request for information and is not an offer to sell, a solicitation of an offer to buy, or
a sale of the Securities. The Investor also understands that the Investor may be required to furnish additional information.


 


PLEASE NOTE THE FOLLOWING
INSTRUCTIONS BEFORE COMPLETING THIS INVESTOR QUESTIONNAIRE.


 


Unless instructed otherwise,
the Investor should answer each question on the Questionnaire. If the answer to a particular question is “None” or
“Not Applicable,” please so state. If the Questionnaire does not provide sufficient space to answer a question, please
attach a separate schedule to your executed Questionnaire that indicates which question is being answered thereon. Persons having
questions concerning any of the information requested in this Questionnaire should consult with their purchaser representative
or representatives, lawyer, accountant or broker or may call Amanda C. E. Knab, Esq., Venable LLP, at 410.244.6514.


 


 



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1. General Information


 


Name of Entity: Dolphin
Offshore Partners, L.P.


 


Address of Principal
Office: 4828 First Coast Hwy., Suite 5


 


Fernandina
Beach, FL 32034


 


Type of Organization:
Limited Partnership


 


Date and State of Organization:
July 21, 1989 Delaware


 


 2. Accredited
Investor Status


 


To be qualified to
invest in the Securities, the Investor must be an Accredited Investor.


 


Please check the appropriate
description which applies to you.


 


(a) ____________ A
bank, as defined in Section 3(a)(2) of the Securities Act or any savings and loan association or other institution as defined in
Section 3(a)(5)(A) of the Securities Act, whether acting in an individual or a fiduciary capacity.


 


(b) ____________ A
broker or dealer registered under Section 15 of the Securities Exchange Act of 1934, as amended.


 


(c) ____________ An
insurance company, as defined in Section 2(13) of the Securities Act.


 


(d) ____________ An
investment company registered under the Investment Company Act of 1940 or a business development company, as defined in Section
2(a)(48) of that act.


 


(e) ____________ A
Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the Small Business
Investment Act of 1958.


 


(f) ____________ A
plan established and maintained by a state, its political subdivisions or any agency or instrumentality of a state or its political
subdivisions for the benefit of its employees, if the plan has total assets in excess of $5 million.


 


(g) ____________ An
employee benefit plan within the meaning of Title I of the Employee Retirement Income Security Act of 1974, if the investment decision
is being made by a plan fiduciary, as defined in Section 3(21) of such act, and the plan fiduciary is either a bank, a savings
and loan association, an insurance company, or a registered investment adviser, or if the employee benefit plan has total assets
in excess of $5 million or, if a self-directed plan, with investment decisions made solely by persons that are accredited investors.


 






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(h) ____________ A
private business development company, as defined in Section 202(a)(22) of the Investment Advisers Act of 1940.


 


(i) ____________ A
corporation, Massachusetts or similar business trust, or partnership, or an organization described in Section 501(c)(3) of the
Internal Revenue Code of 1986, as amended, that was not formed for the specific purpose of acquiring the Securities, and that has
total assets in excess of $5 million.


 


(j) _____________ A
trust with total assets in excess of $5 million not formed for the specific purpose of acquiring the Securities, whose purchase
is directed by a sophisticated person as described in Rule 506(b)(2)(ii) under the Securities Act.


 


(k) _____________ An
entity in which all of the equity owners are accredited investors and meet the criteria listed in Part I, Item 2 of this Questionnaire.


 


3. Representations


 


The undersigned entity
represents that:


 


(a) The entity understands
that the Issuer will rely upon the completeness and accuracy of the entity’s responses to the questions in this Questionnaire
in establishing that the contemplated transactions are exempt from the Securities Act, and hereby affirms that all such responses
are accurate and complete. The entity will notify the Issuer immediately of any changes in any of such information occurring prior
to the acceptance of its subscription.


 


(b) The entity is not
a retirement plan, employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974, as amended
(“ERISA”) or Section 4975 of the IRS Code (or an entity whose assets are deemed to include assets of those plans under
the Department of Labor’s “plan asset regulation”), a corporate pension and profit-sharing plan, a “simplified
employee pension plan,” a “Keogh” plan, an Individual Retirement Account,  or retirement or employee benefit
plan not subject to ERISA.


 


 


 


[SIGNATURE PAGE FOLLOWS]


 




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	Individual	 
	 	 	 
	 	 
	Name		 
	 	 	 
	 	 
	Signature 	 	 
	 	 	 
	 	 
	Date:	 	 
	 	 	 
	 	 	 
	 	 	 
	Partnership, Corporation or Other Entity
	 	 	 
	Dolphin Offshore Partners, L.P.
	Print or Type Name 
	 	 	 
	By:	 	 
	 	 	 
	Name: Peter E. Salas 
	 	 	 
	Title: General Partner 
	 	 	 
	Date: