Form of First Year Executive Change of Control Severance Agreement



 Exhibit 10.10 
 BLUEARC CORPORATION 
 FIRST YEAR CHANGE OF CONTROL SEVERANCE
AGREEMENT 
 This First Year Change of Control Severance Agreement (the “Agreement”) is made and entered into
by and between [name of executive] (“Executive”) and BlueArc Corporation (the “Company”), effective as of [date of agreement] (the “Effective Date”). 

RECITALS 

A. It is expected that the Company from time to time will consider the possibility of an acquisition by another company or other change
of control. The Board of Directors of the Company (the “Board”) recognizes that such consideration can be a distraction to Executive and can cause Executive to consider alternative employment opportunities. The Board has determined that it
is in the best interests of the Company and its stockholders to assure that the Company will have the continued dedication and objectivity of Executive, notwithstanding the possibility, threat or occurrence of a Change of Control (as defined herein)
of the Company. 
 B. The Board believes that it is in the best interests of the Company and its stockholders to provide
Executive with an incentive to continue his employment and to motivate Executive to maximize the value of the Company upon a Change of Control for the benefit of its stockholders. 

C. The Board believes that it is imperative to provide Executive with certain benefits upon Executive’s termination of employment
following a Change of Control. These benefits will provide Executive with enhanced financial security and incentive and encouragement to remain with the Company notwithstanding the possibility of a Change of Control. 

D. Certain capitalized terms used in the Agreement are defined in Section 5 below. 

AGREEMENT 

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties hereto agree as follows: 

1. Term of Agreement. This Agreement will have a term of one (1) year from the Effective Date, unless terminated earlier
under this Agreement’s provisions, Notwithstanding the foregoing provisions of this paragraph, in the event of a Change of Control, the term of this Agreement will automatically extend through the eighteen-month anniversary of such Change of
Control. If Executive becomes entitled to severance benefits pursuant to Section 3 hereof, this Agreement will not terminate until all of the obligations under this Agreement have been satisfied. 

2. At-Will Employment. The Company and Executive acknowledge that Executive’s employment is and will continue to be at-will.
As an at-will employee, either the Company or the Executive may terminate the employment relationship at any time, with or without Cause. If Executive’s employment terminates for any reason, including (without limitation) any termination








 
prior to a Change of Control, Executive will not be entitled to any payments, benefits, damages, awards or compensation other than as provided by this Agreement or as provided in any employment
agreement entered into between the Company and Employee, and the payment of accrued but unpaid wages, as required by law, and any unreimbursed reimbursable expenses. 
 3. Severance Benefits. 
 (a) Involuntary Termination Following a Change
of Control. If on or within six (6) months following a Change of Control the Company (or any parent or subsidiary of the Company) terminates Executive’s employment without Cause, or the Executive resigns from such employment for Good
Reason, and Executive signs and does not revoke a standard release of claims with the Company in a form reflected in Exhibit “A” hereto, provided that such release of claims becomes effective and irrevocable no later than sixty
(60) days following the termination date or such earlier date required by the release agreement (such deadline, the “Release Deadline”), then subject to this Section 3, Executive will receive the following: 

(i) Severance Payment. Executive will receive severance pay (less applicable withholding taxes) in the form of a lump sum payment
equivalent to six (6) months of Executive’s base salary (as in effect immediately prior to (A) the Change of Control, or (B) Executive’s termination, whichever is greater). 

(ii) Continued Employee Benefits. Whether or not Executive elects to continue and pay his health insurance coverage under the
Consolidated Omnibus Budget Reconciliation Act (“COBRA”) following the termination of his Employment, the Company shall pay him an amount equal to twice what the monthly premium would be under COBRA for Executive and his covered dependents
until the earlier of (A) a period of six (6) months from the last date of employment of the Executive with the Company, or (B) the date upon which Executive and/or Executive’s eligible dependents becomes covered under similar
plans. The reimbursements will be made by the Company to Executive consistent with the Company’s normal expense reimbursement policy. 
 (iii) Equity Awards. Twenty-five percent (25%) of Executive’s then outstanding and unvested awards relating to the Company’s common stock (whether stock options, stock appreciation
rights, shares of restricted stock, restricted stock units, performance shares, performance units or otherwise (collectively, the “Equity Awards”)) will vest and thereafter otherwise will remain subject to the terms and conditions of the
applicable Equity Award agreement. 
 (b) Timing of Payments. 

(i) If the release of claims does not become effective by the Release Deadline, Executive will forfeit any rights to severance or
benefits under this Agreement. In no event will severance payments or benefits be paid or provided until the release of claims becomes effective and irrevocable. In the event the termination occurs at a time during the calendar year when the release
of claims could become effective in the calendar year following the calendar year in which Executive’s termination occurs (whether or not it actually becomes effective in the following year), then any severance payments or benefits under this
Agreement that would be 

  
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considered Deferred Compensation Severance Benefits (as defined in Section 3(f)(i) will be paid on the first payroll date to occur during the calendar year following the calendar year in
which such termination occurs, or, if later, the latest to occur of: (A) the date the release of claims becomes effective and irrevocable, (B) such time as required by the payment schedule applicable to each payment or benefit as set forth
in Section 3(a), or (C) such time as required by Section 3(f). 
 (ii) Unless otherwise required by
Section 3(f), the Company will pay any severance payments set forth in Section 3(a) in a lump-sum payment payable within fifteen (15) days following Executive’s termination date; provided, however, that no severance or other
benefits, other than the accrued compensation set forth in Section 3(g), will be paid or provided until the release of claims becomes effective and irrevocable, and such severance amounts or benefits otherwise payable between Executive’s
termination date and the date such release becomes effective and irrevocable will be paid on the date the release becomes effective and irrevocable. If Executive should die before all of the severance amounts have been paid, such unpaid amounts will
be paid in a lump-sum payment promptly following such event to Executive’s designated beneficiary, if living, or otherwise to the personal representative of Executive’s estate. 

(c) Voluntary Resignation; Termination For Cause. If Executive’s employment with the Company terminates (i) voluntarily
by Executive (other than for Good Reason during the period that is on or within six (6) months following a Change of Control) or (ii) for Cause by the Company (or any parent or subsidiary of the Company), then Executive will not be
entitled to receive severance or other benefits except for those (if any) as may then be established under the Company’s then existing severance and benefits plans or pursuant to other written agreements with the Company. 

(d) Disability; Death. If the Company terminates Executive’s employment as a result of Executive’s Disability, or
Executive’s employment terminates due to his death, then Executive will not be entitled to receive severance or other benefits except for those (if any) as may then be established under the Company’s then existing written severance and
benefits plans and practices or pursuant to other written agreements with the Company. 
 (e) Exclusive Remedy. In the
event of a termination of Executive’s employment with the Company (or any parent or subsidiary of the Company) on or within six (6) months following a Change of Control, the provisions of this Section 3 are intended to be and are
exclusive and in lieu of any other rights or remedies to which Executive or the Company may otherwise be entitled, whether at law, tort or contract, in equity, or under this Agreement. Executive will be entitled to no benefits, compensation or other
payments or rights upon termination of employment on or within six (6) months following a Change of Control other than those benefits expressly set forth in this Section 3. 

(f) Section 409A. 
 (i) Notwithstanding anything to the contrary in this Agreement, no severance payable to Executive, if any, pursuant to this Agreement, when considered together with any other severance payments or
separation benefits that are considered deferred compensation under Section 409A of the Internal Revenue Code of 1986, as amended (the “Code”), and the final 

  
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regulations and any guidance promulgated thereunder (“Section 409A”) (together, the “Deferred Compensation Separation Benefits”) will be payable until Executive has a
“separation from service” within the meaning of Section 409A. 
 (ii) Notwithstanding anything to the contrary
in this Agreement, if Executive is a “specified employee” within the meaning of Section 409A at the time of Executive’s termination (other than due to death), then the Deferred Compensation Separation Benefits that are payable
within the first six (6) months following Executive’s separation from service, will become payable on the first payroll date that occurs on or after the date six (6) months and one (1) day following the date of Executive’s
separation from service. All subsequent Deferred Compensation Separation Benefits, if any, will be payable in accordance with the payment schedule applicable to each payment or benefit. Notwithstanding anything herein to the contrary, if Executive
dies following Executive’s separation from service but prior to the six (6) month anniversary of the separation, then any payments delayed in accordance with this paragraph will be payable in a lump sum as soon as administratively
practicable after the date of Executive’s death and all other Deferred Compensation Separation Benefits will be payable in accordance with the payment schedule applicable to each payment or benefit. Each payment and benefit payable under this
Agreement is intended to constitute separate payments for purposes of Section 1.409A-2(b)(2) of the Treasury Regulations. 

(iii) Any amount paid under this Agreement that satisfies the requirements of the “short-term deferral” rule set forth in
Section 1.409A-1(b)(4) of the Treasury Regulations will not constitute Deferred Compensation Separation Benefits for purposes of clause (i) above. 
 (iv) Any amount paid under this Agreement that qualifies as a payment made as a result of an involuntary separation from service pursuant to Section 1.409A-1(b)(9)(iii) of the Treasury Regulations
that does not exceed the Section 409A Limit (as defined below) will not constitute Deferred Compensation Separation Benefits for purposes of clause (i) above. 
 (v) The foregoing provisions are intended to comply with the requirements of Section 409A so that none of the severance payments and benefits to be provided hereunder will be subject to the
additional tax imposed under Section 409A, and any ambiguities herein will be interpreted to so comply. The Company and Executive agree to work together in good faith to consider amendments to this Agreement and to take such reasonable actions
which are necessary, appropriate or desirable to avoid imposition of any additional tax or income recognition prior to actual payment to Executive under Section 409A. 
 (g) Accrued Wages and Vacation; Expenses. Without regard to the reason for, or the timing of, Executive’s termination of employment: (i) the Company will pay Executive any unpaid base
salary due for periods prior to the Termination Date; (ii) the Company will pay Executive all of Executive’s accrued and unused vacation through the Termination Date; and (iii) following submission of proper expense reports by
Executive, the Company will reimburse Executive for all expenses reasonably and necessarily incurred by Executive in connection with the business of the Company prior to the Termination Date. These payments will be made promptly upon termination and
within the period of time mandated by law. 

  
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 4. Limitation on Payments. In the event that the severance and other benefits
provided for in this Agreement or otherwise payable to Executive (i) constitute “parachute payments” within the meaning of Section 280G of the Code and (ii) but for this Section 4, would be subject to the excise tax
imposed by Section 4999 of the Code, then Executive’s severance benefits under Section 4(a)(i) will be either: 

(a) delivered in full, or 
 (b) delivered as to such lesser extent which would result in no portion of such severance benefits being subject to excise tax under Section 4999 of the Code, whichever of the foregoing amounts,
taking into account the applicable federal, state and local income taxes and the excise tax imposed by Section 4999, results in the receipt by Executive on an after-tax basis, of the greatest amount of severance benefits, notwithstanding that
all or some portion of such severance benefits may be taxable under Section 4999 of the Code. If a reduction in severance and other benefits constituting “parachute payments” is necessary so that benefits are delivered to a lesser
extent, reduction will occur in the following order: reduction of cash payments; cancellation of awards granted “contingent on a change in ownership or control” (within the meaning of Code Section 280G), cancellation of accelerated
vesting of equity awards; reduction of employee benefits. In the event that acceleration of vesting of equity award compensation is to be reduced, such acceleration of vesting will be cancelled in the reverse order of the date of grant of
Employee’s equity awards. 
 Unless the Company and Executive otherwise agree in writing, any determination required under
this Section 4 will be made in writing by the Company’s independent public accountants immediately prior to Change of Control (the “Accountants”), whose determination will be conclusive and binding upon Executive and the Company
for all purposes. For purposes of making the calculations required by this Section 4, the Accountants may make reasonable assumptions and approximations concerning applicable taxes and may rely on reasonable, good faith interpretations
concerning the application of Sections 280G and 4999 of the Code. The Company and Executive will furnish to the Accountants such information and documents as the Accountants may reasonably request in order to make a determination under this
Section 4. 
 5. Definition of Terms. The following terms referred to in this Agreement will have the following
meanings: 
 (a) Cause. “Cause” is defined as: (i) acts or omissions constituting gross negligence or
willful misconduct with respect to your obligations or otherwise relating to the business of the Company; (ii) felony conviction of, or felony plea or nolo contender for fraud, misappropriation or embezzlement, or a felony crime of moral
turpitude or conviction of fraud, misappropriation or embezzlement; (iii) willfully or negligently exposing the Company to a risk of civil or criminal legal damages, liabilities or penalties; (iv) violation or breach of any fiduciary duty
or (v) violation of breach of any contractual duty to the Company which duty is material to the performance of your duties or responsibilities or results in material damage to the company or its business; (vi) breach of your Confidential
Information Agreement with the Company; or (vii) engaging in any other act of dishonesty, fraud, intentional misrepresentation, illegality or harassment, which, as determined in good faith by the Board, is reasonably likely to materially


  
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adversely affect the business or reputation of the Company with its current or prospective customers, suppliers, lenders and/or other third parties with whom it does or might do business. The
determination as to whether Executive is being terminated for Cause will be made in good faith by the Company and will be final and binding on Executive. 
 (b) Change of Control. “Change of Control” of the Company is defined as: 
 (i) any “person” (as such term is used in Sections 13(d) and 14(d) of the Securities Exchange Act of 1934, as amended) becomes the “beneficial owner” (as defined in Rule 13d-3 under
said Act), directly or indirectly, of securities of the Company representing fifty percent (50%) or more of the total voting power represented by the Company’s then outstanding voting securities; 

(ii) the consummation of the sale or disposition by the Company of all or substantially all of the Company’s assets; 

(iii) the consummation of a merger or consolidation of the Company with any other corporation, other than a merger or consolidation
which would result in the voting securities of the Company outstanding immediately prior thereto continuing to represent (either by remaining outstanding or by being converted into voting securities of the surviving entity or its parent) at least
fifty percent (50%) of the total voting power represented by the voting securities of the Company or such surviving entity or its parent outstanding immediately after such merger or consolidation; or 

(iv) a change in the composition of the Board occurring within a two (2) year period, as a result of which less than a majority of
the directors are Incumbent Directors. “Incumbent Directors” means directors who either (A) are directors of the Company as of the date hereof, or (B) are elected, or nominated for election, to the Board with the affirmative
votes of at least a majority of the directors of the Company at the time of such election or nomination (but will not include an individual whose election or nomination is in connection with an actual or threatened proxy contest relating to the
election of directors to the Company). 
 (c) Disability. “Disability” will mean that Executive has been unable
to perform his Company duties as the result of his incapacity due to physical or mental illness, and such inability, at least twenty-six (26) weeks after its commencement, is determined to be total and permanent by a physician selected by the
Company or its insurers and acceptable to Executive or Executive’s legal representative (such Agreement as to acceptability not to be unreasonably withheld). Termination resulting from Disability may only be effected after at least thirty
(30) days’ written notice by the Company of its intention to terminate Executive’s employment. In the event that Executive resumes the performance of substantially all of his duties hereunder before the termination of his employment
becomes effective, the notice of intent to terminate will automatically be deemed to have been revoked. 
 (d) Good
Reason. “Good Reason” will mean Executive’s termination of employment within ninety (90) days following the expiration of any cure period (discussed below) following the occurrence of one or more of the following, without
Executive’s consent: (a) a 

  
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significant reduction of Executive’s duties, position or responsibilities relative to Executive’s duties, position or responsibilities in effect immediately prior to such reduction, or
the removal of Executive from such position, duties and responsibilities, unless Executive is provided with comparable or greater duties, position and responsibilities; provided, however, that a reduction in duties, position or responsibilities
solely by virtue of the Company being acquired and made part of a larger entity, whether as a subsidiary, business unit or otherwise (as, for example, when the Chief Financial Officer of the Company remains the Chief Financial Officer of the Company
following a Change in Control where the Company becomes a wholly owned subsidiary of the acquirer, but is not made the Chief Financial Officer of the acquiring corporation) will not constitute “Good Reason;” (b) a material reduction
by the Company of Executive’s base salary and/or benefits as in effect immediately prior to such reduction, other than substantially similar reductions that are also applied to substantially similar employees of the Company; (c) the
imposition of a requirement for the relocation of Executive to a facility or location more than fifty (50) miles from Executive’s current work location; (d) the failure of the Company to obtain the assumption of this Agreement by any
successors contemplated in Section 6, below; or (e) a material breach by the Company of any term or condition of this Agreement, promotion letter dated January 16, 2006 with Executive, or any other agreement between the Company and
Executive. Executive will not resign for Good Reason without first providing the Company with written notice of the acts or omissions constituting the grounds for “Good Reason” within ninety (90) days of the occurrence of the Good
Reason event and a reasonable cure period of not less than thirty (30) days following the date of such notice. 
 (e)
Section 409A Limit. “Section 409A Limit” will mean the lesser of two (2) times: (i) Employee’s annualized compensation based upon the annual rate of pay paid to Employee during the Employee’s taxable
year preceding the Employee’s taxable year of Employee’s termination of employment as determined under, and with such adjustments as are set forth in, Treasury Regulation 1.409A-1(b)(9)(iii)(A)(1) and any Internal Revenue Service guidance
issued with respect thereto; or (ii) the maximum amount that may be taken into account under a qualified plan pursuant to Section 401(a)(17) of the Code for the year in which Employee’s employment is terminated. 

6. Successors. 
 (a) The Company’s Successors. Any successor to the Company (whether direct or indirect and whether by purchase, merger, consolidation, liquidation or otherwise) to all or substantially all of
the Company’s business and/or assets will assume the obligations under this Agreement and will agree expressly to perform the obligations under this Agreement in the same manner and to the same extent as the Company would be required to perform
such obligations in the absence of a succession. For all purposes under this Agreement, the term “Company” will include any successor to the Company’s business and/or assets which executes and delivers the assumption agreement
described in this Section 6(a) or which becomes bound by the terms of this Agreement by operation of law. 
 (b)
Executive’s Successors. The terms of this Agreement and all rights of Executive hereunder will inure to the benefit of, and be enforceable by, Executive’s personal or legal representatives, executors, administrators, successors,
heirs, distributees, devisees and legatees. 

  
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 7. Notice. 
 (a) General. Notices and all other communications contemplated by this Agreement will be in writing and will be deemed to have been duly given when personally delivered or when mailed by U.S.
registered or certified mail, return receipt requested and postage prepaid. In the case of Executive, mailed notices will be addressed to him at the home address which he most recently communicated to the Company in writing. In the case of the
Company, mailed notices will be addressed to its corporate headquarters, and all notices will be directed to the attention of its President. 
 (b) Notice of Termination. Any termination by the Company for Cause or as a result of a voluntary resignation will be communicated by a notice of termination to the other party hereto given in
accordance with Section 7(a) of this Agreement. Such notice will indicate the specific termination provision in this Agreement relied upon, will set forth in reasonable detail the facts and circumstances claimed to provide a basis for
termination under the provision so indicated, and will specify the termination date (which will be not more than thirty (30) days after the giving of such notice). 
 8. Arbitration. 
 (a) Any dispute or controversy arising out of, relating
to, or in connection with this Agreement, or the interpretation, validity, construction, performance, breach, or termination thereof, will be resolved by binding arbitration to be conducted by the Judicial Arbitration and Mediation Services
(“JAMS”) in Santa Clara, California, in accordance with the Employment Arbitration Rules and Procedures of JAMS (the “Rules”). The arbitrator may grant injunctions or other relief in such dispute or controversy. The decision of
the arbitrator will be final, conclusive and binding on the parties to the arbitration. Judgment may be entered on the arbitrator’s decision in any court having jurisdiction. 

(b) The arbitrator will apply California law to the merits of any dispute or claim, without reference to conflicts of law rules. The
arbitration proceedings will be governed by federal arbitration law and by the Rules, without reference to state arbitration law. Executive hereby consents to the personal jurisdiction of the state and federal courts located in California for any
action or proceeding arising from or relating to this Agreement or relating to any arbitration in which the parties are participants. 
 (c) Executive understands that nothing in this Section 8 modifies Executive’s at-will employment status. Either Executive or the Company can terminate the employment relationship at any time,
with or without Cause. 
 (d) EXECUTIVE HAS READ AND UNDERSTANDS THIS SECTION 8, WHICH DISCUSSES ARBITRATION. EXECUTIVE
UNDERSTANDS THAT SUBMITTING ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT, OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH OR TERMINATION THEREOF TO BINDING ARBITRATION, CONSTITUTES A WAIVER OF
EXECUTIVE’S RIGHT TO A JURY TRIAL AND RELATES 

  
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TO THE RESOLUTION OF ALL DISPUTES RELATING TO ALL ASPECTS OF THE EMPLOYER/EXECUTIVE RELATIONSHIP, INCLUDING BUT NOT LIMITED TO, THE FOLLOWING CLAIMS: 

(i) ANY AND ALL CLAIMS FOR WRONGFUL DISCHARGE OF EMPLOYMENT; BREACH OF CONTRACT, BOTH EXPRESS AND IMPLIED; BREACH OF THE COVENANT OF
GOOD FAITH AND FAIR DEALING, BOTH EXPRESS AND IMPLIED; NEGLIGENT OR INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS; NEGLIGENT OR INTENTIONAL MISREPRESENTATION; NEGLIGENT OR INTENTIONAL INTERFERENCE WITH CONTRACT OR PROSPECTIVE ECONOMIC ADVANTAGE; AND
DEFAMATION. 
 (ii) ANY AND ALL CLAIMS FOR VIOLATION OF ANY FEDERAL STATE OR MUNICIPAL STATUTE, INCLUDING, BUT NOT LIMITED TO,
TITLE VII OF THE CIVIL RIGHTS ACT OF 1964, THE CIVIL RIGHTS ACT OF 1991, THE AGE DISCRIMINATION IN EMPLOYMENT ACT OF 1967, THE AMERICANS WITH DISABILITIES ACT OF 1990, THE FAIR LABOR STANDARDS ACT, THE CALIFORNIA FAIR EMPLOYMENT AND HOUSING ACT, AND
LABOR CODE SECTION 201, et seq; 
 (e) ANY AND ALL CLAIMS ARISING OUT OF ANY OTHER LAWS AND REGULATIONS RELATING TO EMPLOYMENT
OR EMPLOYMENT DISCRIMINATION. 
 9. Miscellaneous Provisions. 

(a) No Duty to Mitigate. Executive will not be required to mitigate the amount of any payment contemplated by this Agreement, nor
will any such payment be reduced by any earnings that Executive may receive from any other source. 
 (b) Waiver. No
provision of this Agreement will be modified, waived or discharged unless the modification, waiver or discharge is agreed to in writing and signed by Executive and by an authorized officer of the Company (other than Executive). No waiver by either
party of any breach of, or of compliance with, any condition or provision of this Agreement by the other party will be considered a waiver of any other condition or provision or of the same condition or provision at another time. 

(c) Headings. All captions and section headings used in this Agreement are for convenient reference only and do not form a part of
this Agreement. 
 (d) Entire Agreement. This Agreement constitutes the entire agreement of the parties hereto and
supersedes in their entirety all prior representations, understandings, undertakings or agreements (whether oral or written and whether expressed or implied) of the parties with respect to the subject matter hereof, including, but not limited to,
any rights to severance and/or change of control benefits set forth in Executive’s promotion letter dated January 16, 2006; provided; however, that to the extent any agreement covering Executive’s equity awards outstanding as of the
date of this Agreement provide for vesting acceleration provisions more favorable than that provided for in Section 3 hereof, then the terms of that agreement will govern with respect to that particular equity


  
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award. No waiver, alteration, or modification of any of the provisions of this Agreement will be binding unless in writing and signed by duly authorized representatives of the parties hereto and
which specifically mention this Agreement. 
 (e) Choice of Law. The validity, interpretation, construction and
performance of this Agreement will be governed by the laws of the State of California (with the exception of its conflict of laws provisions). 
 (f) Severability. The invalidity or unenforceability of any provision or provisions of this Agreement will not affect the validity or enforceability of any other provision hereof, which will remain
in full force and effect. 
 (g) Withholding. All payments made pursuant to this Agreement will be subject to withholding
of applicable income and employment taxes. 
 (h) Counterparts. This Agreement may be executed in counterparts, each of
which will be deemed an original, but all of which together will constitute one and the same instrument. 
 IN WITNESS WHEREOF,
each of the parties has executed this Agreement, in the case of the Company by its duly authorized officer, as of the day and year set forth below. 
  

			
	COMPANY:	 	BLUEARC CORPORATION
		
		 	  

		 	By:
		 	Title:
		 	Date:
		
	EXECUTIVE:	 	[NAME OF EXECUTIVE], an individual
		
		 	  

		 	By:
		 	Date:


  
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