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Exhibit 10.01

FIRST AMENDMENT TO THE .NET REGISTRY AGREEMENT

This FIRST AMENDMENT TO THE .NET REGISTRY AGREEMENT (“Amendment 1”) is dated as of 27 April 2020 (the “Amendment 1 Effective Date”) and is entered into by and between the INTERNET CORPORATION FOR ASSIGNED NAMES AND NUMBERS, a California non-profit public benefit corporation (“ICANN”) and VERISIGN, INC., a Delaware corporation (“Verisign”), and amends the parties’ executed .net Registry Agreement effective as of July 1, 2017 (the “Agreement”). Capitalized terms used herein shall have the meanings assigned to them in the Agreement. ICANN and Verisign may be referred to individually as a “Party” and collectively as the “Parties.”

WHEREAS, the Parties agreed in Section 3.1(c)(iv) (Monthly Reporting) of the Agreement to negotiate in good faith to develop a transition plan setting forth the timing and process by which Registry Operator would deliver the monthly operator’s reports with the content and format set forth in Specification 3 of the new gTLD registry agreement;

WHEREAS, the Parties agree that this Amendment 1 satisfies each Party’s obligations under Section 3.1(c)(iv); and

WHEREAS, Verisign and ICANN desire to amend the Agreement as set forth herein.

NOW, THEREFORE, in consideration of the promises, mutual covenants and agreements in this Amendment 1, and other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the Parties agree as follows:

1.The Parties agree to delete Section 3.1(c)(iv) (Monthly Reporting) of the Agreement and replace it in its entirety as follows:

“3.1(c)(iv) Monthly Reporting. Within 20 calendar days following the end of each calendar month, Registry Operator shall prepare and deliver to ICANN reports providing such data and, in the format specified in Appendix 4 (Monthly Operators Reports). Notwithstanding the foregoing, beginning on June 20, 2020, Appendix 4 (Monthly Operators Reports) shall be deleted in its entirety and replaced with Appendix 4A (Format and Content for Registry Operator Monthly Reporting), attached hereto and incorporated herein by this reference, and no later than the 20th calendar day of each calendar month thereafter, Registry Operator shall prepare and deliver to ICANN reports providing such data and in the format set forth in Appendix 4A (Format and Content for Registry Operator Monthly Reporting).”

2.  The Parties agree that, effective as of June 20, 2020, Appendix 4 (Monthly Operators Reports) shall be deleted and replaced in its entirety with Appendix 4A (Format and Content for Registry Operator Monthly Reporting), in the form attached hereto and incorporated herein by this reference, and that all references in the Agreement to Appendix4 (Monthly Operators Reports) shall refer to Appendix 4A (Format and Content for Registry Operator Monthly Reporting).

3.   The Parties agree that the title of Section 7.2(a) (Registry-Level Transaction Fee) of the Agreement shall be deleted and replaced in its entirety as follows:

“7.2(a) Registry-Level Transaction Fee and Sync Transaction Fee.”

4.  The Parties agree to add the following to the end of Section 7.2(a) (Registry-Level Transaction Fee) of the Agreement:

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“For each domain name registration in the TLD for which a registrar extends the registration term pursuant to the Registry Operator’s Consolidate/Sync Service (“Sync Service”) (referenced in Appendix 9 (Approved Services)) on or after May 1, 2020, Registry Operator shall pay ICANN an additional fee, prorated from the amount of US$0.75, based on the number of days the domain name registration is extended past its expiry date through the Sync Service (“Sync Transaction Fee”). For the avoidance of doubt, the Parties agree that the Sync Transaction Fee will not be applied retroactively, and the calculation for payment to ICANN shall begin on May 1, 2020.”

5.  The Parties agree that Section 7.2(b) (Payment Schedule) of the Agreement shall be deleted and replaced in its entirety as follows:

“7.2(b) Payment Schedule. Registry Operator shall pay the Registry-Level Transaction Fees and Sync Transaction Fees specified in Section 7.2(a), the Fixed Registry-Level Fees specified in Section 7.2(c), and the Variable Registry-Level Fees specified in Section 7.2(d), if applicable, by the 20th calendar day following the end of each calendar quarter (i.e., on April 20, July 20, October 20 and January 20 for the calendar quarters ending March 31, June 30, September 30 and December 31) of the year to an account designated by ICANN.”

6.  The Parties agree to delete the first bullet in Appendix 9 of the Agreement and replace it with the following:

“●          Consolidate/Sync Service, in accordance with Registry Operator’s Registrar Reference Manual;”

7.   Agreement; No Other Amendment; Reaffirmation. Except as amended by this Amendment 1, the Agreement shall remain in full force and effect according to its terms and shall be read and construed as if the terms of this Amendment 1 were included therein. The Parties acknowledge and agree that each shall be bound and obligated to perform all of its respective obligations under the Agreement as amended by this Amendment 1, and that all references in such document to the Agreement shall mean and include the Agreement as amended hereby.

8.   Incorporation by Reference. This Amendment 1 incorporates by reference the provisions set forth in Section 8.6 (Amendments and Waivers), Section 8.7 (No Third-Party Beneficiaries), Section 8.8 (Notices, Designations and Specifications), Section 8.9 (Language), Section 8.10 (Counterparts) and Section 8.11 (Entire Agreement), as if fully set forth herein.

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IN WITNESS WHEREOF, ICANN and Verisign have caused this Amendment 1 to be executed and delivered by their duly authorized officers as of the Amendment 1 Effective Date.

									
	INTERNET CORPORATION FOR ASSIGNED NAMES AND NUMBERS		
			
	By: /s/ Göran Marby
		
			
	Name: Göran Marby
		
	Title: President and Chief Executive Officer		
			
	Date: 27 April 2020
		
			
	VERISIGN, INC.
		
			
	By: /s/ D. James Bidzos		
			
	Name: D. James Bidzos		
	Title: President and Chief Executive Officer		
			
	Date: 27 April 2020
		

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.net Registry Agreement Appendix 4A Format and Content for Registry Operator Monthly Reporting
(Effective as of June 20, 2020)

Registry Operator shall provide the following monthly reports, each as described in greater detail below, for the TLD: (1) the Service Level Agreement Performance Report; (2) the Per-Registrar Transactions Report; and (3) the Registry Functions Activity Report. The Service Level Agreement Performance Reports shall be submitted to ICANN via email to
<registryreports@icann.org>. The Per-Registrar Transactions Reports and the Registry Functions Activity Reports shall be submitted to ICANN using the API described in draft- lozano-icann-registry-interfaces, see https://tools.ietf.org/html/draft-lozano-icann-registry- interfaces (the “Registry Interfaces Specification”). If not already an RFC, Registry Operator will use the most recent draft version of the Registry Interfaces Specification available as of June 20, 2020. Registry Operator may at its election use newer versions of the Registry Interfaces Specification after June 20, 2020. Once the Registry Interfaces Specification is published as an RFC, Registry Operator will implement the RFC version no later than one hundred eighty (180) calendar days after it is published.
ICANN may request in the future that the reports be delivered by other means and using other formats. For each of the reports, ICANN will use reasonable commercial efforts to preserve the confidentiality of the information reported until three (3) months after the end of the month to which the reports relate. Unless set forth in this Appendix 4A, any reference to a specific time refers to Coordinated Universal Time (UTC). Monthly reports shall consist of data that reflects the state of the registry at the end of the month (UTC).

1.Service Level Agreement Performance Report. This report shall compare the Service Level Agreement requirements with actual performance measures for the reporting month.

2.Per-Registrar Transactions Report. This report shall be compiled in a comma separated- value formatted file as specified in RFC 4180. The file shall be named “net-transactions- yyyymm.csv.” The file shall contain the following fields per registrar:

									
	Field #	Field name	Description
	01	registrar-name	Registrar’s full corporate name as registered with IANA
	02	iana-id	For cases where the registry operator acts as registrar (i.e., without the use of an ICANN accredited registrar) either 9998 or 9999 should be used depending on registration type, otherwise the sponsoring Registrar IANA id should be used as specified in http://www.iana.org/assignments/registrar-ids
	03	total-domains	total domain names under sponsorship in any EPP status but pendingCreate that have not been purged
	04	total-nameservers	total name servers (either host objects or name server hosts as domain name attributes) associated with domain names registered for the TLD in any EPP status but pendingCreate that have not been purged

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	05	net-adds-1-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of one (1) year (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	06	net-adds-2-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of two(2) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	07	net-adds-3-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of three (3) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	08	net-adds-4-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of four (4) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	09	net-adds-5-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of five (5) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	10	net-adds-6-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of six (6) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	11	net-adds-7-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of seven (7) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	12	net-adds-8-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of eight (8) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	13	net-adds-9-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of nine (9) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	14	net-adds-10-yr	number of domains successfully registered (i.e., not in EPP pendingCreate status) with an initial term of ten (10) years (and not deleted within the add grace period). A transaction must be reported in the month the add grace period ends.
	15	net-renews-1-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of one (1) year (and not deleted within the renew or auto-renew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	16	net-renews-2-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of two (2) years (and not deleted within the renew or auto-renew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	17	net-renews-3-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of three (3) years (and not deleted within the renew or autorenew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.

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	18	net-renews-4-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of four (4) years (and not deleted within the renew or auto-renew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	19	net-renews-5-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of five (5) years (and not deleted within the renew or auto-renew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	20	net-renews-6-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of six (6) years (and not deleted within the renew or auto-renew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	21	net-renews-7-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of seven (7) years (and not deleted within the renew or autorenew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	22	net-renews-8-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of eight (8) years (and not deleted within the renew or autorenew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	23	net-renews-9-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of nine (9) years (and not deleted within the renew or autorenew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	24	net-renews-10-yr	number of domains successfully renewed (i.e., not in EPP pendingRenew status) either automatically or by command with a new renewal period of ten (10) years (and not deleted within the renew or autorenew grace period). A transaction must be reported in the month the renew or auto-renew grace period ends.
	25	transfer-gaining-successful	number of domain transfers initiated by this registrar that were successfully completed (either explicitly or automatically approved) and not deleted within the transfer grace period. A transaction must be reported in the month the transfer grace period ends.
	26	transfer-gaining-nacked	number of domain transfers initiated by this registrar that were rejected (e.g., EPP transfer op="reject") by the other registrar
	27	transfer-losing-successful	number of domain transfers initiated by another registrar that were successfully completed (either explicitly or automatically approved)
	28	transfer-losing-nacked	number of domain transfers initiated by another registrar that this registrar rejected (e.g., EPP transfer op="reject")
	29	transfer-disputed-won	number of transfer disputes in which this registrar prevailed (reported in the month where the determination happened)
	30	transfer-disputed-lost	number of transfer disputes this registrar lost (reported in the month where the determination happened)
	31	transfer-disputed-nodecision	number of transfer disputes involving this registrar with a split or no decision (reported in the month where the determination happened)
	32	deleted-domains-grace	domains deleted within the add grace period (does not include names deleted while in EPP pendingCreate status). A deletion must be reported in the month the name is purged.

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	33	deleted-domains-nograce	domains deleted outside the add grace period (does not include names deleted while in EPP pendingCreate status). A deletion must be reported in the month the name is purged.
	34	restored-domains	domain names restored during reporting period
	35	restored-noreport	total number of restored names for which a restore report is required by the registry, but the registrar failed to submit it
	36	agp-exemption-requests	total number of AGP (add grace period) exemption requests
	37	agp-exemptions-granted	total number of AGP (add grace period) exemption requests granted
	38	agp-exempted-domains	total number of names affected by granted AGP (add grace period) exemption requests
	39	attempted-adds	number of attempted (both successful and failed) domain name create commands
	40	consolidate-transaction-days	total number of days added to the expiration date of all domain names via consolidate/sync transactions. The number of days of a consolidate/sync transaction must be reported here in the month the transaction took place.
	41	consolidate-transactions	total number of consolidate/sync transactions. A transaction must be reported in the month the transaction took place.

The first line shall include the field names exactly as described in the table above as a “header line” as described in section 2 of RFC 4180. The last line of each report shall include totals for each column across all registrars; the first field of this line shall read “Totals” while the second field shall be left empty in that line. No other lines besides the ones described above shall be included. Line breaks shall be <U+000D, U+00A> as described in RFC 4180.

3.             Registry Functions Activity Report.  This report shall be compiled in a comma separated value formatted file as specified in RFC4180. The file shall be named “net-activityyyyymm.csv.” The file shall contain the following fields:

									
	Field #	Field Name	Description
	01	operational-registrars	number of operational registrars in the production system at the end of the reporting period
	02	zfa-passwords	number of active zone file access passwords at the end of the reporting period; "CZDS" may be used instead of the number of active zone file access passwords, if the Centralized Zone Data Service (CZDS) is used to provide the zone file to the end user
	03	whois-43-queries	number of WHOIS (port-43) queries responded during the reporting period
	04	web-whois-queries	number of Web-based Whois queries responded during the reporting period, not including searchable Whois
	05	searchable-whois-queries	number of searchable Whois queries responded during the reporting period, if offered
	06	dns-udp-queries-received	number of DNS queries received over UDP transport during the reporting period
	07	dns-udp-queries-responded	number of DNS queries received over UDP transport that were responded during the reporting period

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	08	dns-tcp-queries-received	number of DNS queries received over TCP transport during the reporting period
	09	dns-tcp-queries-responded	number of DNS queries received over TCP transport that were responded during the reporting period
	10	srs-dom-check	number of SRS (EPP and any other interface) domain name “check” requests responded during the reporting period
	11	srs-dom-create	number of SRS (EPP and any other interface) domain name “create” requests responded during the reporting period
	12	srs-dom-delete	number of SRS (EPP and any other interface) domain name “delete” requests responded during the reporting period
	13	srs-dom-info	number of SRS (EPP and any other interface) domain name “info” requests responded during the reporting period
	14	srs-dom-renew	number of SRS (EPP and any other interface) domain name “renew” requests responded during the reporting period
	15	srs-dom-rgp-restore-report	number of SRS (EPP and any other interface) domain name RGP “restore” requests delivering a restore report responded during the reporting period
	16	srs-dom-rgp-restore-request	number of SRS (EPP and any other interface) domain name RGP “restore” requests responded during the reporting period
	17	srs-dom-transfer-approve	number of SRS (EPP and any other interface) domain name “transfer” requests to approve transfers responded during the reporting period
	18	srs-dom-transfer-cancel	number of SRS (EPP and any other interface) domain name “transfer” requests to cancel transfers responded during the reporting period
	19	srs-dom-transfer-query	number of SRS (EPP and any other interface) domain name “transfer” requests to query about a transfer responded during the reporting period
	20	srs-dom-transfer-reject	number of SRS (EPP and any other interface) domain name “transfer” requests to reject transfers responded during the reporting period
	21	srs-dom-transfer-request	number of SRS (EPP and any other interface) domain name “transfer” requests to request transfers responded during the reporting period
	22	srs-dom-update	number of SRS (EPP and any other interface) domain name “update” requests (not including RGP restore requests) responded during the reporting period
	23	srs-host-check	number of SRS (EPP and any other interface) host “check” requests responded during the reporting period
	24	srs-host-create	number of SRS (EPP and any other interface) host “create” requests responded during the reporting period
	25	srs-host-delete	number of SRS (EPP and any other interface) host “delete” requests responded during the reporting period
	26	srs-host-info	number of SRS (EPP and any other interface) host “info” requests responded during the reporting period
	27	srs-host-update	number of SRS (EPP and any other interface) host “update” requests responded during the reporting period

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	28	srs-cont-check	number of SRS (EPP and any other interface) contact “check” requests responded during the reporting period
	29	srs-cont-create	number of SRS (EPP and any other interface) contact “create” requests responded during the reporting period
	30	srs-cont-delete	number of SRS (EPP and any other interface) contact “delete” requests responded during the reporting period
	31	srs-cont-info	number of SRS (EPP and any other interface) contact “info” requests responded during the reporting period
	32	srs-cont-transfer-approve	number of SRS (EPP and any other interface) contact “transfer” requests to approve transfers responded during the reporting period
	33	srs-cont-transfer-cancel	number of SRS (EPP and any other interface) contact “transfer” requests to cancel transfers responded during the reporting period
	34	srs-cont-transfer-query	number of SRS (EPP and any other interface) contact “transfer” requests to query about a transfer responded during the reporting period
	35	srs-cont-transfer-reject	number of SRS (EPP and any other interface) contact “transfer” requests to reject transfers responded during the reporting period
	36	srs-cont-transfer-request	number of SRS (EPP and any other interface) contact “transfer” requests to request transfers responded during the reporting period
	37	srs-cont-update	number of SRS (EPP and any other interface) contact “update” requests responded during the reporting period

The first line shall include the field names exactly as described in the table above as a “header line” as described in section 2 of RFC 4180. No other lines besides the ones described above shall be included. Line breaks shall be <U+000D, U+000A> as described in RFC 4180.

For gTLDs that are part of a single-instance Shared Registry System, the Registry Functions Activity Report may include the total contact or host transactions for all the gTLDs in the system.
9Exhibit 10.1

  

  

  

  
    CHANGE IN CONTROL AND SEVERANCE AGREEMENT

    

    

    This Change in Control and Severance Agreement (this “Agreement”) is made and entered into by and between [●] (the “Employee”)

      and Tengasco, Inc. (the “Company”), effective as of [●] (the “Effective Date”).

    

    

    RECITALS

    

    

    WHEREAS, this Agreement is designed to reduce the uncertainty faced by the Employee in the
        face of any potential change in control by providing the Employee the opportunity to receive severance pay in the event of an actual or constructive involuntary termination of employment following a change in control.

    

    

    WHEREAS, this Agreement is not intended to satisfy the qualification requirements of Code
        Section 401 but is intended to comply with or be exempt from the requirements of Code Section 409A and the Treasury regulations and guidance issued thereunder.

    

    

    DEFINITIONS

    

    

    As used herein, the following words and phrases shall have the following respective meanings unless the context clearly indicates otherwise.

     

    (a)        Affiliate.  Each of the following: (a) any subsidiary corporation (within the meaning of Section 424 of the Code; (b) any parent corporation (within the meaning of Section 424 of
      the Code); (c) any corporation, trade or business (including, without limitation, a partnership or limited liability company) which is directly or indirectly controlled 50% or more (whether by ownership of stock, assets or an equivalent ownership
      interest or voting interest) by the Company or one of its Affiliates; (d) any trade or business (including, without limitation, a partnership or limited liability company) which directly or indirectly controls 50% or more (whether by ownership of
      stock, assets or an equivalent ownership interest or voting interest) of the Company; and (e) any other entity in which the Company or any of its Affiliates has a material equity interest and which is designated as an “Affiliate” by resolution of the
      Company.

     

    (b)         Anniversary Date.  Each anniversary of the date that the Employee begins employment with the Employer.

     

    (c)          Base Pay.  The Employee’s weekly base pay, determined as follows:

     

    (i)          Hourly Employees.  If the Employee is paid on an hourly basis, the regular hourly rate of pay on the Employee’s Date of Termination multiplied by 52 (which is the number of paid
      hours per week after taking into account overtime pay, based on the average 48-hour work week of all hourly employees).

     

    (ii)         Salaried Employees.  If the Employee’s paid on a salary basis, the annualized base salary in effect on the Employee’s Date of Termination, divided by 52 (the number of weeks in a
      year).

     

    
      
        

    

    
    (d)         Cause.  A good faith determination of the Company of any of the following: (i) commission of any act of dishonesty or fraud by the Employee which is intended to result in the
      Employee’s personal enrichment at the expense of the Company or its Affiliates; (ii) the Employee’s willful violation of his or her responsibilities or legal obligations to the Company or any of its Affiliates; or (iii) the Employee’s conviction
      (after the exhaustion of all appeals) or plea of nolo contendere to any felony involving moral turpitude.

     

    (e)          Change in Control.   The earliest of the following events:

     

    (i)          the consummation of a merger, consolidation, share exchange or similar transaction of the Company with any other corporation, entity or group, as a result of which the holders of the
      voting capital stock of the Company immediately prior to such merger, consolidation, share exchange or similar transaction, as a group, would hold less than 50% of the voting capital stock of the Company or the surviving or resulting corporation, as
      applicable;

     

    (ii)          the sale or transfer (other than as security for obligations of the Company) of substantially all the operating assets of the Company; or

     

    (iii)        the individuals who, as of the Effective Date, constitute the Company’s board of directors (the “Incumbent Board”) cease for any reason to
      constitute at least a majority of the board; provided, however, that any individual becoming a director subsequent to the Effective Date whose election, or nomination for election by the Company’s stockholders, was approved by a vote of at least a
      majority of the directors then comprising the Incumbent Board shall be considered as though such individual were a member of the Incumbent Board.

     

    (f)         Change in Control Protection Period.  The period beginning on the date of a Change in Control and ending twelve (12) months thereafter; provided, however, that if the Employee has
      a termination of employment prior to a Change in Control at the request of the buyer or otherwise in contemplation of the Change in Control, such termination shall be deemed to have occurred within the Change in Control Protection Period.

     

    (g)         Code.  The Internal Revenue Code of 1986, as amended from time to time.

     

    (h)         Date of Termination.  The date on which the Employee’s employment with the Employee’s Employer terminates.

     

    (i)          Employer.  The Company or Related Entity that is the common law employer of the Employee.

     

    (j)        Good Reason.  With respect to the Employee’s termination of employment, any of the following events or conditions which occur without the Employee’s written consent, and which
      remain in effect after notice has been provided by the Employee to the Employer of such event or condition and the expiration of a 30 day cure period: (i) a reduction in the Employee’s Base Pay, (ii) for any Employee paid on an hourly basis, an
      involuntary reduction in average hours of weekly employment, (iii) a change of more than fifty (50) miles in the geographic location at which Employee primarily performs his or her services, or (iv) failure to offer the Employee substantially similar
      employee benefits at substantially the same cost as the employee benefits that were offered to the Employee immediately preceding the Change in Control.  The Employee’s notification to the Company must be in writing and must occur within a reasonable
      period of time, not to exceed 60 days, following the Employee’s discovery of the relevant event or condition.

     

    
      - 2 -

      
        

    

    (k)         Qualifying Termination. Employee’s employment with an Employer is terminated during the Change in Control Protection Period due to an involuntary termination by the Employer
      without Cause (which shall not include a termination as a result of the Employee’s death or disability),  or due to a termination by the Employee for Good Reason; provided, however, that a Qualifying Termination shall not be deemed to
      have occurred where the Employee is offered but refuses to accept continued employment following the Change in Control with compensation and benefits that are no less favorable than those provided to the Employee prior to the Change in Control and
      with a principal job location within 50 miles of the geographic location at which such Employee was performing services immediately prior to the Change in Control (including, for avoidance of doubt, refusal to accept such offered employment with any
      purchaser of the Kansas assets of the Company subsequent to the Change in Control transaction).

     

    (l)         Related Entity.  Any Affiliate that is treated as the same “service recipient” or “employer” as the Company pursuant to Treasury Regulation Section 1.409A-1(h)(3), and any
      successor to such entity.

     

    (m)        Severance Pay.  Cash severance payable to the Employee as determined pursuant to Section 2(a) of this Agreement.

     

    (n)         Year of Service. Each one-year period and fraction thereof, beginning on the date the Employee is hired or rehired by the Company or any Related Entity and measured in respect of
      each Anniversary Date thereof through the Change in Control, during which period the Employee is continuously employed by an Employer, provided, however, that periods during which the Employee is on an approved leave of absence shall be treated as
      periods of continuous employment. In addition, the Employer shall adjust the Employee’s hire date to take into account prior service if the Employee terminated employment and was rehired within a period of less than 1 full year.

     

    AGREEMENT

    

    

    (1)          No Contract of Employment.  The execution of this Agreement does not, and shall not be deemed to, guarantee the Employee’s employment with the Company or an
      Affiliate for any specific period and does not alter the at-will nature of the employment relationship between the Employer and the Employee.  Accordingly, the Employee or the Employer may terminate the employment relationship as freely and with the
      same effect as if this Agreement had not been executed at any time, with or without Cause or Good Reason, at the option of either party, with or without notice.  Any representation contrary to the previous two sentences shall be invalid unless
      obtained in writing and signed by a duly authorized representative of the Company. If the Employee’s employment terminates for any reason, the Employee shall not be entitled to any payments, benefits, damages, awards or compensation other than as
      provided by this Agreement or as may otherwise be available in accordance with the Company’s established employee arrangements.

    

    

    
      - 3 -

      
        

    

    
      (2)        Severance Pay.

    

    

    

    (a)         Amount.  The amount of Severance Pay payable to Employee upon a Qualifying Termination shall be [26 weeks of Base Pay] 1 [two weeks of Base Pay for
      each full completed Year of Service, plus a pro-rated number of weeks of Base Pay based on the foregoing formula for any partially completed Year of Service (which pro-rated amount may include fractional weeks of Base Pay), up to a maximum of 26
      weeks of Base Pay]2.

    

    

    (b)         Payment.  All Severance Pay shall be paid in a single lump sum within ten days after the Release required by Section 3 has been executed and has become
      effective and irrevocable.

    

    

    (c)         Offset. To the extent permitted under Section 409A of the Code, the Employee’s Severance Pay under this Agreement shall be reduced by any amount that the
      Employee owes to the Employer or any Related Entity on the Employee’s Date of Termination.

    

    

    (3)         Release.  As a condition precedent to the payment or provision of the amounts or benefits due under Section 2, the Employee must execute a release in substantially the form
      attached hereto as Exhibit A (the “Release”) within forty-five (45) days following the Date of Termination and not revoke such Release within the subsequent seven (7) day revocation period (if applicable).

    

    

    (4)        Successors and Assigns. This Agreement shall bind any successor of the Company, its assets or its businesses as in existence immediately prior to the Change in Control
      (whether direct or indirect, by purchase, merger, consolidation or otherwise), in the same manner and to the same extent that the Company would be obligated under this Agreement if no succession had taken place.  In the case of any transaction in
      which a successor would not by the foregoing provision or by operation of law be bound by this Agreement, the Company shall require such successor expressly and unconditionally to assume and agree to perform the Company’s obligations under this
      Agreement, in the same manner and to the same extent that the Company would be required to perform if no such succession had taken place.  The term “Company,” as used in this Agreement, shall mean the Company
      as hereinbefore defined and any successor or assignee to the business or assets which by reason hereof becomes bound by this Agreement.

    

    

    (5)        Term. This Agreement shall continue in full force and effect until the date that is eighteen (18) months following the Effective Date, and shall then automatically terminate;
      provided, however, that if Employee becomes entitled to any payments hereunder shall continue to receive such payments notwithstanding any termination of the Agreement.

     

    

    
      

    
      1 NTD: To be used for the Company’s CFO.

      2 NTD: To be used for all Employees other than the Company’s CFO.

    

    

    

    
      - 4 -

      
        

    

    (6)         Section 409A.

    

    

    (a)         General.  The payments and benefits provided hereunder are intended to be exempt from or compliant with the requirements of Section 409A of the Code. 
      Notwithstanding any provision of this Agreement to the contrary, in the event that the Company reasonably determines that any payments or benefits hereunder are not either exempt from or compliant with the requirements of Section 409A of the Code,
      the Company shall have the right to adopt such amendments to this Agreement or adopt such other policies and procedures (including amendments, policies and procedures with retroactive effect), or take any other actions, that are necessary or
      appropriate (i) to preserve the intended tax treatment of the payments and benefits provided hereunder, to preserve the economic benefits with respect to such payments and benefits, and/or (ii) to exempt such payments and benefits from Section 409A
      of the Code or to comply with the requirements of Section 409A of the Code and thereby avoid the application of penalty taxes thereunder; provided, however, that this section does not, and shall not be construed so as to, create any obligation on the
      part of the Company to adopt any such amendments, policies or procedures or to take any other such actions or to indemnify any Employee for any failure to do so.

    

    

    (b)        Exceptions to Apply.  The Company shall apply the exceptions provided in Treasury Regulation Section 1.409A-1(b)(4), Treasury Regulation Section
      1.409A-1(b)(9) and all other applicable exceptions or provisions of Code Section 409A to the payments and benefits provided under this Agreement so that, to the maximum extent possible, (i) such payments and benefits are not deemed to be
      “nonqualified deferred compensation” subject to Code Section 409A, and (ii) such payments and benefits are not subject to the payment delay required by Section 6(c) below.  All payments and benefits provided under this Agreement shall be deemed to be
      separate payments (and any payments made in installments shall be deemed a series of separate payments) for purposes of Code Section 409A.

    

    

    (c)         Specified Employee.  Notwithstanding anything to the contrary in this Agreement, no compensation or benefits that are “nonqualified deferred
      compensation” subject to Code Section 409A shall be paid to the Employee during the 6-month period following his or her Date of Termination to the extent that the Company determines that the Employee is a “specified employee” as of the Date of
      Termination and that paying such amounts at the time or times indicated in this Agreement would be a prohibited distribution under Code Section 409A(a)(2)(B)(i).  If the payment of any such amounts is delayed as a result of the previous sentence,
      then on the first business day following the end of such 6-month period (or such earlier date upon which such amount can be paid under Code Section 409A without being subject to such additional taxes, including as a result of the Employee’s death),
      the Company shall pay to the Employee a lump-sum amount equal to the cumulative amount that would have otherwise been payable to the Employee during such 6-month period.

    

    

    (d)        Taxable Reimbursements.  To the extent that any payments or reimbursements provided to the Employee are deemed to constitute “nonqualified deferred compensation”
      subject to Code Section 409A, such amounts shall be paid or reimbursed reasonably promptly, but not later than December 31 of the year following the year in which the expense was incurred.  The amount of any payments or expense reimbursements that
      constitute compensation in one year shall not affect the amount of payments or expense reimbursements constituting compensation that are eligible for payment or reimbursement in any subsequent year, and the Employee’s right to such payments or
      reimbursement of any such expenses shall not be subject to liquidation or exchange for any other benefit.

    

    

    
      - 5 -

      
        

    

    (7)        Unfunded Status.   All payments pursuant to this Agreement shall be made from the general funds of the Company (or if so provided by the Company, the relevant Employer) and no
      special or separate fund shall be established or other segregation of assets made to assure payment.  The Employee shall not have under any circumstances any interest in any particular property or assets of the Company or any Affiliate as a result of
      this Agreement.

    

    

    (8)         Nonalienation.  The Employee shall have no right or ability to pledge, hypothecate, anticipate, assign, or otherwise transfer any benefit
      or right under this Agreement, except by will or the laws of descent and distribution.

    

    

    (9)         Validity and Severability.  The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision of this
      Agreement, which shall remain in full force and effect, and any prohibition or unenforceability in any jurisdiction shall not invalidate or render unenforceable such provision in any other jurisdiction.

    

    

    (10)     Governing Law.  The validity, interpretation, construction and performance of this Agreement shall in all respects be governed by the laws of Colorado, without reference to
      principles of conflict of law, except to the extent pre-empted by federal law.

    

    

    (11)       Dispute Resolution.  Any controversy or claim under this Agreement (a “Dispute”) shall be settled by binding arbitration in the City and
      County of Denver,  Colorado in accordance with the rules of the American Arbitration Association then applicable to employment-related disputes and any judgment upon any award, which may include an award of damages, may be entered in the state or
      federal court having jurisdiction over such award.  The prevailing party in any such action or proceeding shall be entitled to reasonable attorneys’ fees and costs.

    

    

    (12)      Notices.  All notices and all other communications which are required to be given under this Agreement must be in writing and shall be deemed to have been duly given when (i)
      personally delivered, (ii) mailed by United States registered or certified mail postage prepaid, (iii) sent via a nationally recognized overnight courier service, (iv) sent via facsimile to the recipient, or (v) sent via e-mail to the recipient, in
      each case (A) if to the Company, to the Company’s Chief Financial Officer at 8000 E. Maplewood Ave., Suite 130, Greenwood Village, CO  80111 (or to the Company’s then-current headquarters if different than above), or to the Chief Financial Officer’s
      then-current e-mail or facsimile, and (B) if to the Employee, to the most recent contact information on file with the Employer.

    

    

    (13)      Payment Obligation May be Satisfied by Employer; Tax Withholding.  The Company may satisfy any payment obligation under this Agreement by having the Employer of the Employee
      make the payment due hereunder.  All payments made to Employee in accordance with the provisions of this Agreement shall be subject to applicable withholding of local, state, federal, and foreign taxes, as determined in the sole discretion of the
      Company or the Employer making such payment.

    

    

    
      - 6 -

      
        

    

    (14)     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.

    

    

    (15)       Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which together will constitute one and the same instrument.

    

    

    (16)      Amendment. No modifications or amendments to this Agreement shall be binding on the parties unless and until such modifications or amendments are executed in writing by an
      authorized representative of each party.

    

    

    -Signature Page Follows-

     

    

    
      - 7 -

      
        

    

    IN WITNESS WHEREOF, the undersigned have executed this Change In Control and Severance
        Agreement on the Effective Date.

    

    

    	 	
            THE COMPANY

          
	 	 
	 	
            TENGASCO, INC.

          

    

    

    	 	
            By:

          	 

    	 	
            Name:

          	 
	 	
            Title: 

            

          	 

    

    

    	 	
            EMPLOYEE

          

     

    

    	 	
            By:

          	 

    	 	
            Name:

          	 

    

    

    
      
        

    

    Exhibit A

     

    Form of Release

     

    See attached.

     

    
      
        

    

    GENERAL RELEASE OF CLAIMS

     

    This General Release (“Release”) is entered into as of [•], by and between Tengasco, Inc. (the “Company”), and [•], an employee of the Company (the “Employee”) (collectively, the “Parties”).

     

    WHEREAS, Employee’s employment with the Company is being terminated effective [•]; and

     

    WHEREAS, the Parties wish to terminate their relationship amicably and to resolve, fully and finally, all actual and potential Claims (defined below) and disputes relating to Employee’s employment with and termination
      from the Company and all other relationships between Employee and the Company, up to and including the date of execution of this Release.

     

    NOW, THEREFORE, in consideration of the promises and mutual covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are expressly acknowledged, the Parties,
      intending to be legally bound, agree as follows:

     

    
      
        	
                1.

              	
                Termination of Employment.  Employee’s employment with the Company shall terminate on [•] (the “Date of Termination”).

              

      

    

     

    
      
        	
                2.

              	
                Severance Benefits.  In consideration of Employee’s release of Claims and the other covenants and agreements contained herein, and provided that Employee has signed this Release and delivered it to
                  the Company and has not exercised any revocation rights as provided in Section 6 below, the Company shall provide to Employee the severance benefits described in Section 2 of that certain Change in Control and Severance Agreement (the “Severance

                    Agreement”), between Employee and the Company, dated on or about the date hereof (the “Benefits”) in the time and manner provided therein.  If Employee breaches any of the provisions of this Release or of any other agreement
                  Employee has with the Company, the Company’s obligations as described in this Release may be excused in whole or in part in the Company’s sole discretion.  Employee acknowledges and agrees that the Benefits constitute good and valuable
                  consideration beyond that to which Employee would be entitled to receive from the Company if Employee elected not to sign this Release.  Reporting of and withholding on any payment under this Section for tax purposes shall be performed by
                  the Company in conformance with applicable tax laws.

              

      

    

     

    
      
        	
                3.

              	
                Effective Date.  Provided that it has not been revoked pursuant to Section 6 hereof, this Release will become effective on the eighth (8th) calendar day after the date of its execution by Employee
                  (the “Effective Date”).  Employee acknowledges and agrees that if Employee revokes this Release pursuant to Section 6 hereof, Employee will have no right to receive the Benefits.

              

      

    

     

    
      
        	
                4.

              	
                General Release.  In consideration of the Company’s obligations under this Release, Employee hereby releases, acquits and forever discharges the Company and each of its subsidiaries and affiliates
                  and each of their respective officers, employees, directors, agents, contractors, successors and assigns (collectively, the “Released Parties”) from any and all claims, actions or causes of action in any way related to Employee’s
                  employment with the Company or the termination thereof, or related to Employee’s relationship(s) with the Released Parties, whether arising from tort, common law, statute, contract or Company plan, including but not limited to, (a) claims
                  of wrongful discharge, breach of contract, breach of implied contract, failure to keep any promise, breach of a covenant of good faith and fair dealing, breach of fiduciary duty, estoppel, reliance upon any representation, Employee’s
                  activities, if any, as an actual or alleged “whistleblower,” defamation, infliction of emotional distress, outrageous conduct, fraud, misrepresentation, negligence, harassment, retaliation or reprisal, constructive discharge, assault,
                  battery, false imprisonment, invasion of privacy, interference with contractual or business relationships, any other wrongful employment practices, or violation of any other principle of common law, (b) claims arising under Title VII of
                  the Civil Rights Act of 1964 and 1991, the Americans with Disabilities Act, the Rehabilitation Act of 1973, the Age Discrimination in Employment Act, 42 U.S.C. Section 1981, the Older Worker Benefit Protection Act, the Employee Retirement
                  Income Security Act, the Equal Pay Act, the Family Medical Leave Act, the Lilly Ledbetter Fair Pay Act of 2009, the Genetic Information Non-discrimination Act, the Worker Adjustment and Retraining Notification Act, the Fair Credit
                  Reporting Act, or (c) claims arising under the discrimination, wage payment, or employment laws and any other federal, state or local statutes or ordinances of the United States, it being Employee’s intention and the intention of the
                  Company to make this Release as broad and as general as the law permits (the “Claims”).  Employee understands that this Release does not waive claims that the law does not allow to be waived, claims that may arise after the date on
                  which the Release is executed, or claims related to breach or enforcement of this Release.

              

      

    

     

    
      
        

    

    
    
      
        	
                5.

              	
                Unknown Facts.  This Release includes Claims of every nature and kind, known or unknown, suspected or unsuspected.  Employee hereby
                    acknowledges that Employee may hereafter discover facts different from, or in addition to, those which Employee now knows or believes to be true with respect to this Release, and Employee agrees that this Release and the covenants
                    contained herein shall be and remain effective in all respects, notwithstanding such different or additional facts or the discovery thereof.

              

      

    

    

    

    
      
        	
                6.

              	
                Review and Revocation Period.  Employee acknowledges that the Company has advised Employee that Employee may consult with an attorney of Employee’s own choosing (and at Employee’s expense) concerning
                  the terms of this Release prior to signing this Release and that Employee has been given at least twenty-one (21) calendar days during which to consider the provisions of this Release, although Employee may sign and return it sooner.  In
                  the event that Employee signs this Release prior to the expiration of the twenty-one (21) day period, Employee voluntarily waives the right to review this Release for any remaining portion of the twenty-one (21) day period.  Employee
                  further acknowledges that Employee has been advised by the Company that after executing this Release, Employee will have seven (7) calendar days to revoke this Release, and that this Release shall not become effective or enforceable until
                  such seven (7) day revocation period has expired.  Employee acknowledges and agrees that if Employee wishes to revoke this Release, Employee must do so in writing, and that such revocation must be signed by Employee and received by the
                  Chief Financial Officer of the Company no later than 5:00 p.m. on the seventh (7th) calendar day after Employee has executed this Release. Employee acknowledges and agrees that, in the event that Employee revokes this Release, Employee
                  will have no right to receive any benefits hereunder, including the Benefits. Employee represents that Employee has read this Release and understands its terms and enters into this Release freely, voluntarily and without coercion.

              

      

    

     

    
      
        	
                7.

              	
                Confidentiality and Property Return.  Except as otherwise provided herein, Employee agrees to keep the existence and terms of this Release confidential, as well as reaffirms Employee’s general
                  obligation to keep the Company’s non-public confidential, proprietary and trade secret business and financial information strictly confidential, including, without limitation, business, personnel, or financial information (other than
                  information relating to possible violations of federal law or regulation that is reported to any governmental agency or entity, or otherwise making disclosures that are protected under the whistleblower provisions of federal law or
                  regulation).  Employee understands and acknowledges that Employee’s obligations pursuant to any confidentiality agreement signed by Employee and the Company (“Confidentiality Agreement”) survive and continue after the Date of
                  Termination.  Employee represents and warrants that, prior to Employee’s execution of this Release, Employee will return to the Company any and all property, documents, and files, including any documents (in any recorded media, such as
                  papers, drives, computer disks, copies, photographs, maps, transparencies, and microfiche) that relate in any way to the Company or the Company’s business and will retain no copies in any form.

              

      

    

     

    
      2

      
        

    

    
      
        	
                8.

              	
                Non-Admission of Liability.  Nothing in this Release will be construed as an admission of liability by Employee or the Released Parties; rather, Employee and the Released Parties are resolving all
                  matters arising out of any relationship between Employee and the Company and all other relationships between Employee and the Released Parties.

              

      

    

     

    	9.	
            Acknowledgments and Warranties.

          

     

    (a) Employee admits, acknowledges, and agrees that Employee has been fully and finally paid or provided all wages, compensation, accrued but unused vacation time, bonuses, or other benefits from the
      Company which are or could be due to Employee under the terms of Employee’s employment with the Company or otherwise.

     

    (b) Employee warrants and represents that Employee has no knowledge of the existence of any lawsuit, charge, or proceeding against the Company or any of its officers, directors,
      board members, committee members, employees, successors, affiliates, or agents arising out of or otherwise connected with any of the matters herein released.

    

    

    (c) Employee has had an opportunity to discuss any complaints or concerns with the Company and acknowledges that Employee has raised no complaints or concerns with the Company.

    

    

    (d) Employee acknowledges and understands that this Release does not prohibit or prevent Employee from filing a charge with the Equal Employment Opportunity Commission, or
      equivalent state agency, or from participating in a federal or state agency investigation, or from making a complaint to any federal or state agency as authorized by law.  Notwithstanding the foregoing, Employee waives any right to any monetary
      recovery or other relief should any party, including, without limitation, any federal, state or local governmental entity or administrative agency, pursue any claims on Employee’s behalf arising out of, relating to, or in any way connected with the
      released Claims.

    

    

    (e) Employee has not previously disclosed any information which would be a violation of the Confidentiality Agreement or the confidentiality provisions set forth in Section 7 if
      such disclosure were to be made after the execution of this Release.

    

    

    	10.	
            Section 409A.  This Release is intended to comply with or be exempt from Section 409A of the Code and Treasury Regulations promulgated
                thereunder (“Section 409A”) and shall be construed accordingly.  It is the intention of the Parties that payments or benefits payable under this Release shall not be subject to the additional tax or interest imposed pursuant to
                Section 409A, and the provisions of Section 6 of the Severance Agreement shall apply to the Benefits provided herein.

          

     

    
      3

      
        

    

    	11.	
            No Application.  Employee agrees that Employee will not apply for any job or position as an employee, consultant, independent contractor,
                or otherwise, with the Company or its subsidiaries or affiliates.  Employee warrants that no such applications are pending at the time this Release is executed.

          

     

    	12.	
            Miscellaneous.

          

     

    (a) Binding Effect. This Release will be binding upon the Parties and their respective heirs, administrators, representatives, executors, successors and assigns, and will inure to the benefit
      of the Parties and their respective heirs, administrators, representatives, executors, successors and assigns.

     

    (b)  Governing Law and Venue.  This Release will be governed by and construed and enforced in accordance with the laws of the State of Colorado, without giving effect to its statutes or
      precedent concerning conflicts of laws, except to the extent pre-employed by Federal law.  Any dispute concerning this Release will be resolved in accordance with Section 11 of the Severance Agreement.

     

    
      (c)  Severability.  Each of the respective rights and obligations of the Parties hereunder will be deemed independent and may be enforced independently irrespective of any of the other
        rights and obligations set forth herein.  If any provision of this Release should be held illegal or invalid, such illegality or invalidity will not affect in any way other provisions hereof, all of which will continue, nevertheless, in full force
        and effect.  The Parties authorize a court of competent jurisdiction to modify this Release, if necessary, to make it enforceable tot the maximum extent permitted by law.

    

     

    (d) Counterparts. This Release may be signed in counterparts and each counterpart will be deemed to be an original but together all such counterparts will be deemed a single agreement.

     

    (e) Entire Agreement; Modification.  This Release and the Severance Agreement constitute the entire understanding between the Parties with respect to the subject matter hereof and may not be
      modified without the express written consent of both Parties.  This Release supersedes all prior written and/or oral and all contemporaneous oral agreements, understandings, or negotiations between or among the Parties.  This Release may not be
      modified or canceled in any manner except by a writing signed by both Parties.  The failure of any party to insist upon strict performance of any of the terms or conditions of this Release shall not constitute a waiver of any of such party’s rights
      hereunder.

     

    
      
        	
                13.

              	
                Acceptance.  Employee may confirm the acceptance of the terms and conditions of this Release by signing and returning two (2) original copies of this Release to the Chief Financial Officer of the
                  Company, no later than 5:00 p.m. forty-five (45) calendar days after Employee’s Date of Termination. If Employee does not execute this Release in the time noted above, this Release and the consideration offered herein, will be deemed
                  withdrawn.

              

      

    

     

    
      4

      
        

    

    EMPLOYEE ACKNOWLEDGES AND REPRESENTS THAT EMPLOYEE HAS FULLY AND CAREFULLY READ THIS RELEASE PRIOR TO SIGNING IT AND UNDERSTANDS ITS TERMS. EMPLOYEE FURTHER ACKNOWLEDGES AND AGREES THAT EMPLOYEE HAS BEEN, OR HAS HAD
      THE OPPORTUNITY TO BE, ADVISED BY INDEPENDENT LEGAL COUNSEL OF EMPLOYEE’S OWN CHOICE AS TO THE LEGAL EFFECT AND MEANING OF EACH OF THE TERMS AND CONDITIONS OF THIS RELEASE, AND IS ENTERING INTO THIS RELEASE FREELY AND VOLUNTARILY AND NOT IN RELIANCE
      ON ANY PROMISES OR REPRESENTATIONS OTHER THAN AS SET FORTH IN THIS RELEASE.

     

    
      5

      
        

    

    IN WITNESS WHEREOF, the Company and the Employee have duly executed this Release as of the date first above written.

     

    	
            TENGASCO, INC.

          	
            EMPLOYEE

          
	
            By

          	 	
            By

          	 
	 	 	 	 
	
            Date

          	 	
            Date

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