Document:

exv10w1

Exhibit 10.1

ARROW ELECTRONICS, INC.

NORTH AMERICAN COMPONENTS OPERATION

7459 SOUTH LIMA STREET

ENGLEWOOD, CO 80112

April 8, 2011

Mr. Joseph V. Gulfo

President & CEO, MELA Sciences, Inc.

50 South Buckhout Street, Suite 1

Irvington, NY 10533

Re: Letter of Understanding Regarding Proposed Terms of Sale

Dear Mr. Gulfo:

     In consideration of the soon to be established credit limit of $75.0K, and re-payment terms of
net 30-days, MELA Sciences, Inc. and Arrow Electronics, Inc. agree to the following:

	 	1.	 	MELA Sciences will deposit $500,000.00 USD into an escrow account, #***, for the
benefit of MELA, which will be held in trust, interest free, and be applied to the invoices
described herein, and according to the attached payment schedule. This payment is to be made
via a wire transfer of funds to Arrow’s bank. That wire address being:

Bank Name: JP Morgan Chase Bank

Bank Address: 10410 Highland Manor Drive, Tampa, FL 33610

ABA Routing #: 021000021

SWIFT #: CHASUS33

Account #: ***

Bank Telephone No: 212-552-5729

Bank Contact Name: Max Toscano

	 	2.	 	With respect to the Last Time Buy Agreement (LTB), CYII4SM1300AA-QDC, MELA Sciences
has with Cypress Semiconductor Corporation (who was recently acquired by On Semiconductor
Corporation and who will honor the LTB Agreement between the parties), MELA will provide
Arrow with a purchase order for *** Cypress components, specifically part number
CYII4SM1300AA-QDC, with a per unit price of $*** USD. The total value of these components is
$1,265,039.90 USD. After the trust deposit mentioned above is received, Arrow will acquire,
from Cypress, the LTB components mentioned above after a Non-Cancelable, Non-Returnable
(NCNR) contract is executed by MELA Sciences.

	 	3.	 	Arrow will be the facilitator by which components are returned, or credited, if the
yield is not 90.0% as stated in section 5.1 of the Cypress Agreement. Pursuant to the LTB
Agreement Cypress should replace, or credit, nonconforming goods in excess of the 10% agreed
upon rate within 30 days following notice to Cypress from MELA Sciences regarding the same.
Cypress will deliver replacement sensors to the MELA/Askion facility and will remit all
credits to MELA Sciences through Arrow. Arrow shall credit MELA Sciences immediately
following its receipt of any such

 

			
	***

	 	This material has been omitted pursuant to a request for confidential treatment filed
separately with the Securities and Exchange Commission.

 

 

	 	 	 	credit from Cypress.

	 	4.	 	MELA Sciences understands that there is a lead-time of approximately 20 weeks for
Arrow to acquire the named components from Cypress. Arrow will promptly notify MELA Sciences
once these components are available and ready for shipment. If there are unusual delays
Arrow will promptly notify MELA Sciences.
	 
	 	5.	 	Once the components are available for delivery MELA Sciences agrees to accept twelve
(12) consecutive monthly shipments of *** pieces in accordance with the attached schedule,
the first shipment to take place immediately.
	 
	 	6.	 	Each of the twelve shipments will be booked with net 30-day terms, and each for
$105,420.00 USD, plus any applicable tax, freight and handling fees. Arrow will apply
$41,666.67 from the funds held in trust to each of the twelve invoices. MELA Sciences agrees
to remit eleven (11) on-time payments of $63,753.33 net-30 days, subject to any credit
issued, and one (1) final on-time payment of $63,753.23. At the same time MELA Sciences
agrees to remit any applicable taxes, freight charges and handling fees with each of the
twelve payments. See attached schedule.
	 
	 	7.	 	If at any time MELA Sciences is unable to pay its obligation under this arrangement,
Arrow reserves the right to use the balance of the trust deposit to satisfy the remaining
obligation and to seek after any legal means available to it in order to satisfy the amount
still owing. If for any reason Cypress notifies MELA Sciences, or Arrow, that it will no
longer be providing the sensors contemplated hereby, or cannot do so within three (3) months
of the delivery schedule attached hereto, then upon MELA Science’s request Arrow shall
promptly remit the remainder of any funds in the trust account held by it for MELA Sciences
and this agreement shall terminate.

     Please acknowledge your acceptance of the above by signing below and returning the original
executed document to me at the above address.

Sincerely,

ARROW ELECTRONICS INC.

Michael Fassula, Account Finance Manager

303-645-8705 Telephone

	 	 	 	 	 
	 	 	 
	/s/ Joseph V. Gulfo
 	 	April 8, 2011
	Joseph V. Gulfo, President & CEO, MELA Sciences, Inc. 	 	Date 
	 	 	 
	 

 

			
	***

	 	This material has been omitted pursuant to a request for confidential treatment filed
separately with the Securities and Exchange Commission.

 

 

MELA Sciences, Inc. Shipment & Payment Schedule

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Shipment Schedule	 	Payment Schedule
	 	 	Components Shipped	 	Parts Remaining To	 	 	 	 
	Month	 	To MELA	 	Be Shipped	 	Payment From Trust	 	MELA Sciences Pays*
	1
	 	 	0	 	 	 	0	 	 	$	—	 	 	$	(500.000.00	)
	2
	 	 	0	 	 	 	0	 	 	$	—	 	 	$	—	 
	3
	 	 	0	 	 	 	0	 	 	$	—	 	 	$	—	 
	4
	 	 	0	 	 	 	0	 	 	$	—	 	 	$	—	 
	5
	 	 	*	**	 	 	*	**	 	$	—	 	 	$	—	 
	6
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	7
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	8
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	9
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	10
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	11
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	12
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	13
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	14
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	15
	 	 	*	**	 	 	*	**	 	$	41,666.67	 	 	$	63,753.33	 
	16
	 	 	*	**	 	 	0	 	 	$	41,666.67	 	 	$	63,753.33	 
	17
	 	 	0	 	 	 	0	 	 	$	41,666.67	 	 	$	63,753.33	 

 

			
	*	 	Plus Applicable Taxes, Freight & Handling Charges

			
	 
	***

	 	This material has been omitted pursuant to a request for confidential treatment filed
separately with the Securities and Exchange Commission.exv10w1

Exhibit 10.1

Federal Signal Corporation

2005 Executive Incentive Compensation Plan (2010 Restatement)

Performance Based Restricted Stock Unit — Award Agreement

     You have been selected to receive a grant of Performance Based Restricted Stock Units
pursuant to the Federal Signal Corporation 2005 Executive Incentive Compensation Plan (2010
Restatement) (the “Plan”), as specified below:

     Employee:                                                              
                                       

     Date of Grant:                                                            
                     

     Earnings Per Share Target:                                                             

     Earnings Per Share Threshold:                                                             

     Earnings Per Share Maximum:                                                             

     Performance Based Restricted Stock Units Granted:                     

     Performance Period: January 1, 2011 through December 31, 2011

     Vesting Period: January 1, 2011 through December 31, 2013

     This Award shall be subject to the terms and conditions prescribed in the Federal Signal
Corporation 2005 Executive Incentive Compensation Plan (2010 Restatement) and in the Federal Signal
Corporation Performance Based Restricted Stock Unit Award Agreement No. 2011 attached hereto.

This document constitutes part of the prospectus covering
securities that have been registered under the Securities Act of 1933.

     IN WITNESS WHEREOF, the parties have caused this Award Agreement to be executed on this
____________ day of __________________________.

	 	 	 	 	 

	 	 	FEDERAL SIGNAL CORPORATION
	 
	 	 	 	 
	 

	 	By:	 	 
	 

	 	 	 	 
	 
	 	 	 	 
	 

	 	Title:	 	 
	 

	 	 	 	 
	 
	 	 	 	 
	 

	 	 	 	Company
	 
	 	 	 	 
	 

	 	By:	 	 
	 

	 	 	 	 
	 
	 	 	 	 
	 

	 	 	 	Employee

1

 

FEDERAL SIGNAL CORPORATION

PERFORMANCE BASED RESTRICTED STOCK UNIT

AWARD AGREEMENT NO. 2011

     The Company established the Federal Signal Corporation 2005 Executive Incentive Compensation
Plan (2010 Restatement) (the “Plan”) pursuant to which options, stock appreciation rights,
restricted stock and stock units and performance shares covering an aggregate of 7,800,000 shares
of the Stock of the Company may be granted to employees and directors of the Company and its
Subsidiaries;

     The Board of Directors of the Company, and the Administrator of the Plan appointed by the
Board of Directors, has determined that the interests of the Company will be advanced by
encouraging and enabling certain of its employees to own shares of the common stock of the Company,
and that Employee is one of those employees;

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

Section 1. Definitions

          As used in this Agreement, the following terms shall have the following meanings:

          A. “Award” means the award provided for in Section 2.

          B. “Board of Directors” means the Board of Directors of the Company.

          C. “Change in Control” shall have the meaning ascribed to such term in the Plan.

          D. “Company” means Federal Signal Corporation.

          E. “Date of Grant” of Performance Based Restricted Stock Units means the date set forth on the
Award Agreement applicable those Units.

          F. “Earnings Per Share from Continuing Operations” means diluted (loss) earnings per share
from continuing operations determined in accordance with GAAP and as reported in the Company’s Form
10-K for the respective year, subject to certain discretionary adjustments as approved by the
Compensation and Benefits Committee of the Board of Directors.

          G. “Earnings Per Share Maximum” means the maximum level of Earnings Per Share from Continuing
Operations set forth in the Award Agreement.

          H. “Earnings Per Share Target” means the target level of Earnings Per Share from Continuing
Operations set forth in the Award Agreement.

2

 

          I. “Earnings Per Share Threshold” means the threshold level of Earnings Per Share from
Continuing Operations set forth in the Award Agreement.

          J. “Employee” means the individual shown as the recipient of an award of Performance Based
Restricted Stock Units, as set forth on the Award Agreement applicable those Units.

          K. “GAAP” means U.S. generally accepted accounting principles.

          L. “Performance Based Restricted Stock Unit” means the obligation of the Company to transfer
the number of shares of Stock to Employee prescribed in Section 2, at the time provided in Section
5 of this Agreement, provided such Performance Based Restricted Stock Unit is vested at such time.

          M. “Performance Period” means the calendar year period set forth in the Award Agreement.

          N. “Permanent Disability” means Employee is unable to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment that can be expected
to result in death or can be expected to last for a continuous period of not less than twelve
months.

          O. “Stock” means the common stock of the Company.

          P. “Subsidiary” means any corporation or other legal entity, other than the Company, in an
unbroken chain of entities beginning with the Company if, at the relevant date, each of such
entities, other than the last entity in the unbroken chain, owns stock possessing fifty percent or
more of the total combined voting power with respect to one of the other entities in such chain.

          Q. “Vesting Period” means the three consecutive calendar year period set forth in the Award
Agreement.

Section 2. Award

     Subject to the terms of this Agreement, the Company awarded to Employee the number of
Performance Based Restricted Stock Units set forth on the Award Agreement applicable those Units,
effective as of the Date of Grant set forth on such instrument.

     A Performance Based Restricted Stock Unit Award entitles the Employee to receive a whole
number of shares of Stock equal to a percentage, from zero to two hundred percent, based on the
Earnings Per Share from Continuing Operations during the Performance Period, of the number of
Performance Based Restricted Stock Units that are subject to the Award, as described in this
Section.

3

 

     If the Company’s Earnings Per Share from Continuing Operations is less than the Earnings Per
Share Threshold, the Employee shall be entitled to receive no shares of Stock with respect to the
Performance Based Restricted Stock Units subject to the Award. If the Company’s Earnings Per
Share from Continuing Operations is equal to the Earnings Per Share Threshold, the Employee shall
be entitled to receive shares of Stock equal to fifty percent (50%) of the Performance Based
Restricted Stock Units subject to the Award. If the Company’s Earnings Per Share from Continuing
Operations is equal to the Earnings Per Share Target, the Employee shall be entitled to receive
shares of Stock equal to one hundred percent (100%) of the Performance Based Restricted Stock Units
subject to the Award. If the Company’s Earnings Per Share from Continuing Operations is equal to
or greater than the Earnings Per Share Maximum, the Employee shall be entitled to receive shares of
Stock equal to two hundred percent (200%) of the Performance Based Restricted Stock Units subject
to the Award.

     If the Company’s Earnings Per Share from Continuing Operations is another amount between the
Earnings Per Share Target and, as applicable, the Earnings Per Share Threshold or the Earnings Per
Share Maximum, the Employee will receive a percentage of the Performance Based Restricted Stock
Units subject to the Award determined through straight line interpolation to Earnings Per Share
Target. For example, if the Company’s Earnings Per Share from Continuing Operations is $0.75, the
Earnings Per Share Target is $1.00 and the Earnings Per Share Threshold is $.50, the Employee shall
be entitled to receive shares of Stock equal to 75% of the Performance Based Restricted Stock Units
subject to the Award.

     This grant of Performance Based Restricted Stock Units shall not confer any right to the
Employee (or any other Employee) to be granted Performance Based Restricted Stock Units or other
Awards in the future under the Plan.

Section 3. Bookkeeping Account

     The Company shall record the number of Performance Based Restricted Stock Units granted
hereunder to a bookkeeping account for Employee (the “Performance Based Restricted Stock Unit
Account”). Employee’s Performance Based Restricted Stock Unit Account shall be reduced by the
number of Performance Based Restricted Stock Units, if any, forfeited in accordance with Section 4
and by the number of Performance Based Restricted Stock Units with respect to which shares of Stock
were transferred to Employee in accordance with Section 5.

Section 4. Vesting

     Subject to the accelerated vesting provisions provided below, the Performance Based Restricted
Stock Units subject to the Award shall vest on the last day of the Vesting Period, if Employee
remains employed by the Company or its Subsidiaries through such date.

     For the avoidance of doubt, if the Company fails to achieve at least the Earnings Per Share
Threshold, an Employee shall be entitled to receive no shares of Stock with respect to the
Performance Based Restricted Stock Units subject to the Award (as described in Section 2), unless
the deemed Earnings Per Share from Continuing Operations provisions in this Section specifically
modify such result.

4

 

     If, during the Performance Period:

          A. The Employee dies or terminates employment on account of his or her Permanent Disability,
the Performance Based Restricted Stock Units subject to the Award shall be vested, pro rata (based
on the number of full and partial months of the Employee’s employment during the Performance Period
divided by twelve), based on Earnings Per Share from Continuing Operations during the Performance
Period; or

          B. A Change in Control occurs, the Performance Based Restricted Stock Units subject to the
Award shall be vested, pro rata (based on the number of full and partial months during the
Performance Period before the date of the Change in Control, divided by twelve), and the Earnings
Per Share from Continuing Operations shall be deemed to be 100% of the Earnings Per Share Target,
regardless of actual performance.

     If, after the Performance Period but during the Vesting Period:

          A. The Employee dies or terminates employment on account of his or her Permanent Disability or
by reason of retirement (as determined by the Company, in its sole and absolute discretion), the
Performance Based Restricted Stock Units subject to the Award shall be immediately fully vested,
based on Earnings Per Share from Continuing Operations during the Performance Period; or

          B. A Change in Control occurs, the Performance Based Restricted Stock Units subject to the
Award shall be immediately fully vested, based on Earnings Per Share from Continuing Operations
during the Performance Period.

     Except as provided in 4.1 below, in the event of the termination of employment of Employee
with the Company and its Subsidiaries for any other reason before the end of the Vesting Period,
all Performance Based Restricted Stock Units that are not vested at the time of such termination of
employment normally shall be forfeited.

Section 4.1 Acceleration of Vesting of Shares in the Event of Divestiture of Business Segment

     In the event that the “Business Segment” (as that term is defined in this Section below) in
which the Employee is primarily employed as of the “Divestiture Date” (as that term is defined in
this Section below) is the subject of a “Divestiture of a Business Segment” (as that term is
defined in this Section below), and such divestiture results in the termination of the Employee’s
employment with the Company and its subsidiaries for any reason, the Performance Based Restricted
Stock Units subject to the Award shall be vested: (A) in the case of a Divestiture of a Business
Segment during the Performance Period, pro rata, based on the number of full and partial months of
Employee’s employment during the Performance Period before the Divestiture Date, divided by twelve;
or (B) in the case of a Divestiture of a Business Segment after the Performance Period but during
the Vesting Period, fully. If the Divestiture Date occurs during the Performance Period, the
Earnings Per Share from Continuing Operations shall be deemed to be 100% of the Earnings Per Share
Target, regardless of actual performance. If the Divestiture

5

 

Date occurs after the Performance Period but during the Vesting Period, the Earnings Per Share from
Continuing Operations during the Performance Period shall control.

     For purposes of this Agreement, the term “Business Segment” shall mean a business line which
the Company treats as a separate business segment under the segment reporting rules under GAAP,
which currently includes the following: Safety and Security Group, Fire Rescue, Environmental
Solutions Group, and Federal Signal Technologies Group. Likewise, the term “Divestiture Date”
shall mean the date that a transaction constituting a Divestiture of a Business Segment is finally
consummated.

     For purposes of this Agreement, the term “Divestiture of a Business Segment” means the
following:

	 	(a)	 	When used with a reference to the sale of stock or other securities of a
Business Segment that is or becomes a separate corporation, limited liability company,
partnership or other separate business entity, the sale, exchange, transfer,
distribution or other disposition of the ownership, either beneficially or of record or
both, by the Company or one of its subsidiaries to “Nonaffiliated Persons” (as that
term is defined in this Section below) of 100% of either (i) the then-outstanding
common stock (or the equivalent equity interests) of the Business Segment or (ii) the
combined voting power of the then-outstanding voting securities of the Business Segment
entitled to vote generally in the election of the board of directors or the equivalent
governing body of the Business Segment;

	 
	 	(b)	 	When used with reference to the merger or consolidation of a Business Segment
that is or becomes a separate corporation, limited liability company, partnership or
other separate business entity, any such transaction that results in Nonaffiliated
Persons owning, either beneficially or of record or both, 100% of either (i) the
then-outstanding common stock (or the equivalent equity interests) of the Business
Segment or (ii) the combined voting power of the then-outstanding voting securities of
the Business Segment entitled to vote generally in the election of the board of
directors or the equivalent governing body of the Business Segment; or

	 
	 	(c)	 	When used with reference to the sale of the assets of the Business Segment, the
sale, exchange, transfer, liquidation, distribution or other disposition of all or
substantially all of the assets of the Business Segment necessary or required to
operate the Business Segment in the manner that the Business Segment had been operated
prior to the Divestiture Date.

Section 5. Distribution of Shares

     Subject to the provisions below, the number of shares of Stock earned in accordance with
Section 2, determined as of the end of the Performance Period, with respect to Performance Based
Restricted Stock Units that become vested in accordance with Section 4, shall become distributable
as of the end of the Vesting Period (regardless of whether the shares vest earlier).

6

 

     If a Change in Control occurs during the Performance Period, notwithstanding anything in this
Agreement to the contrary, the number of shares of Stock earned in accordance with Section 2, with
respect to Performance Based Restricted Stock Units that become vested in accordance with Section
4, shall become distributable on the date of the Change in Control.

     If an Employee terminates employment due to a Permanent Disability during the Vesting Period,
notwithstanding anything in this Agreement to the contrary, the number of shares of Stock earned in
accordance with Section 2, determined as of the end of the Performance Period, with respect to
Performance Based Restricted Stock Units that become vested in accordance with Section 4, shall
become distributable on the later of the Employee’s Permanent Disability or the end of the
Performance Period (regardless of whether the shares vest earlier).

     Such shares of Stock shall be distributed as soon as administratively feasible after the date
prescribed above; but no later than the later of (a) the end of the calendar year in which the
specified date occurs; or (b) the 15th day of the third calendar month following such
specified date, provided the Employee is not permitted to designate the taxable year of the
payment.

Section 6. Shareholder Rights

     Employee shall not have any of the rights of a shareholder of the Company with respect to
Performance Based Restricted Stock Units, such as the right to vote or the right to dividends.

Section 7. Death Benefits

     The number of shares of Stock earned in accordance with Section 2, determined as of the end
of the Performance Period, with respect to Performance Based Restricted Stock Units that become
distributable on account of the death of an Employee during the Vesting Period, shall be payable
to the Employee’s Beneficiary or Beneficiaries upon the later of the Employee’s death or the end
of the Performance Period (regardless of whether the shares vest earlier). Actual payment will
occur as soon as administratively feasible after such shares become payable, but no later than the
later of two and one-half months after such date or the end of the calendar year in which such
date occurs.

     Employee may designate a Beneficiary or Beneficiaries (contingently, consecutively, or
successively) of such death benefit and, from time to time, may change his or her designated
Beneficiary. A Beneficiary may be a trust. A beneficiary designation shall be made in writing in
a form prescribed by the Company and delivered to the Company while the Participant is alive. If
there is no designated Beneficiary surviving at the death of a Participant, payment of any death
benefit of the Participant shall be made to the persons and in the proportions which any death
benefit under the Federal Signal Corporation Employees’ Profit Sharing and Savings Plan is or would
be payable.

7

 

Section 8. Units Non-Transferable

     Performance Based Restricted Stock Units awarded hereunder shall not be transferable by
Employee. Except as may be required by the federal income tax withholding provisions of the Code
or by the tax laws of any State, the interests of Employee and his or her Beneficiaries under this
Agreement are not subject to the claims of their creditors and may not be voluntarily or
involuntarily sold, transferred, alienated, assigned, pledged, anticipated, or encumbered. Any
attempt by Employee or a Beneficiary to sell, transfer, alienate, assign, pledge, anticipate,
encumber, charge or otherwise dispose of any right to benefits payable hereunder shall be void.

Section 9. Adjustment in Certain Events

     If there is any change in the Stock by reason of stock dividends, split-ups, mergers,
consolidations, reorganizations, combinations or exchanges of shares or the like, the number of
Performance Based Restricted Stock Units credited to Employee’s Performance Based Restricted Stock
Unit Account shall be adjusted appropriately so that the number of Performance Based Restricted
Stock Units credited to Employee’s Performance Based Restricted Stock Unit Account after such an
event shall equal the number of shares of Stock a shareholder would own after such an event if the
shareholder, at the time such an event occurred, had owned shares of Stock equal to the number of
Performance Based Restricted Stock Units credited to Employee’s Performance Based Restricted Stock
Unit Account immediately before such an event.

Section 10. Tax Withholding

     The Company shall not be obligated to transfer any shares of Stock until Employee pays to the
Company or a Subsidiary in cash, or any other form of property, including Stock, acceptable to the
Company, the amount required to be withheld from the wages of Employee with respect to such
shares. Employee may elect to have such withholding satisfied by a reduction of the number of
shares of Stock otherwise transferable under this Agreement at such time, such reduction to be
calculated based on the closing market price of the Stock on the day Employee gives written notice
of such election to the Company.

Section 11. Source of Payment

     Shares of Stock transferable to Employee, or his or her Beneficiary, under this Agreement may
be either Treasury shares, authorized but unissued shares, or any combination of such stock. The
Company shall have no duties to segregate or set aside any assets to secure Employee’s right to
receive shares of Stock under this Agreement. Employee shall not have any rights with respect to
transfer of shares of Stock under this Agreement other than the unsecured right to receive shares
of Stock from the Company.

Section 12. Continuation of Employment

     This Award Agreement shall not confer upon the Employee any right to continuation of
employment by the Company, nor shall this Award Agreement interfere in any way with the Company’s
right to terminate the Employee’s employment at any time.

8

 

Section 13. Amendment

     This Agreement may be amended by mutual consent of the parties hereto by written agreement.

Section 14. Governing Law

     This Agreement shall be construed and administered in accordance with the laws of the State
of Illinois.

9

 

FEDERAL SIGNAL CORPORATION

PERFORMANCE BASED RESTRICTED STOCK UNIT

BENEFICIARY DESIGNATION

	 	 	 	 	 	 	 

	Employee:

	 	 	 	 	 	Social Security No.:                     
	 

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	Address:

	 	 	 	 	 	Date of Birth:                                         
	 

	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 
	 	 	 	 	 

     Employee hereby designates the following individual(s) or entity(ies) as his or her
beneficiary(ies) pursuant to Federal Signal Corporation 2005 Executive Incentive Compensation
Plan (2010 Restatement) (Insert Name, Social Security Number, Relationship, Date of Birth
and Address of Individuals and/or fully identify any trust beneficiary by the Name of the Trust,
Date of Execution of the Trust, the Trustee’s Name, the address of the trust, and the employer
identification number of the trust):

	 	 	 

	Primary Beneficiary(ies)

	 	 
	 
	 
	 	 
	 
	 	 
	 
	 
	 	 
	 
	 	 
	 
	 	 
	Contingent Beneficiary(ies)
	 	 
	 
	 
	 	 
	 
	 	 
	 
	 
	 	 
	 
	 	 

The Participant hereby reserves the right to change this Beneficiary Designation, and any such
change shall be effective when the Participant has executed a new or amended Beneficiary
Designation form, and the receipt of such form has been acknowledged by the Corporation, all in
such manner as specified by the Corporation from time to time, or on a future date specified by any
such new or amended Beneficiary Designation form.

     IN WITNESS WHEREAS, the Participant has executed this Beneficiary Designation on the date
designated below.

	 	 	 	 	 

	 

	 	 	 	 
	Date:                     , ____

	 	 	 	Signature of Employee
	 
	 	 	 	 
	Received:
	 	 	 	 
	 

	 	 	 	Federal Signal Corporation
	 
	 	 	 	 
	Date:                     , ____

	 	By:	 	 
	 

	 	 	 	 

10

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