Document:

EX 10.2-ExchangeAgmtDebtforUnrestrictedStock3625Notes

Exhibit 10.2

EXCHANGE AGREEMENT  
(Unrestricted Stock)
___________________ (the “Undersigned”), for itself and on behalf of the beneficial owners listed on Exhibit A hereto (“Accounts”) for whom the Undersigned holds contractual and investment authority (each Account, as well as the Undersigned if it is exchanging Notes (as defined below) hereunder, a “Holder”), enters into this Exchange Agreement (the “Agreement”) with Forest City Enterprises, Inc., an Ohio corporation (the “Company”) on February 27, 2015 whereby the Holders will exchange (the “Exchange”) the Company’s 3.625% convertible senior notes due 2020 (the “Notes”) for shares of the Company’s Class A common stock, par value $0.331⁄3 per share (the “Common Stock”), and a cash payment.
On and subject to the terms and conditions set forth in this Agreement, the parties hereto agree as follows:
Article I:  Exchange of the Notes for Common Stock
At the Initial Closing (as defined herein), the Undersigned hereby agrees to cause the Holders to exchange and deliver to the Company the following Notes, and in exchange therefor the Company hereby agrees to issue to the Holders the number of shares of Common Stock described below and, following the 20 Day VWAP Period, at the Second Closing (each as defined herein), to pay in cash, an amount as described below:
		
	Aggregate Principal Amount of Notes to be Exchanged: 
	$______________________________         (the “Exchanged Notes”).

Number of Shares of Common Stock to be issued per Note in Exchange: 41.3129 shares (the “Shares”).  All fractional shares shall be rounded up or down to the nearest whole Share.
Aggregate Cash Payment, that will be equal to accrued but unpaid interest on such Notes through the Initial Closing Date, plus the Purchase Calculation Amount, as calculated below (the “Cash Payment”).

For purposes of this Agreement, the “Purchase Calculation Amount” shall mean an amount per $1,000 principal amount of Notes equal to $______________ (the “Exchange Price”) minus the Conversion Value.  The Conversion Value is an amount per $1,000 principal amount of Notes equal to (i) 26.8534 multiplied by [the closing reference stock price] plus 14.4595 multiplied by the 20 Day VWAP.  “20 Day VWAP” means the average of the Daily VWAP beginning on and including February 27, 2015 and ending on and including March 26, 2015 (such period, the “20 Day VWAP Period” to be extended, in the event that the NYSE (as defined below) is closed for trading during any business day that falls within the 20 Day VWAP Period, by the number of business days that such exchange was closed), provided that the 20 Day VWAP will not be less than 90% of the closing reference stock price or more than 110% of the closing reference stock price.  “Daily VWAP”  means, for any trading day, the per share volume-weighted average price as displayed under the heading “Bloomberg VWAP” on Bloomberg page FCE/A<equity>VWAP” (or its equivalent successor if such page is not available) in respect of the period from the scheduled open of trading until the scheduled close of trading of the primary trading session on such trading day up to and including the final closing print (which is indicated by Condition Code “6” in Bloomberg) (or if such volume-weighted average price is unavailable, the market value of one share of our common stock on such trading day determined, using a volume-weighted average method, by a nationally recognized independent investment banking firm retained for this purpose by us).  The “daily VWAP” will be determined without regard to after-hours trading or any other trading outside of the regular trading session trading hours.
The closing of the Exchange shall take place on two separate dates (each, a “Closing”).  The initial Closing (the “Initial Closing”) shall occur on March 4, 2015 (the “Initial Closing Date”), a date three business days after the date of this Agreement.  At the Initial Closing, (a) each Holder shall deliver or cause to be delivered to the Company all right, title and interest in and to its Exchanged Notes (and no other consideration)

    

free and clear of any mortgage, lien, pledge, charge, security interest, encumbrance, title retention agreement, option, equity or other adverse claim thereto (collectively, “Liens”), together with any documents of conveyance or transfer that the Company may deem necessary or desirable to transfer to and confirm in the Company all right, title and interest in and to the Exchanged Notes free and clear of any Liens, and (b) the Company shall deliver to each Holder the number of Shares specified above (or, if there are no Accounts, the Company shall deliver to the Undersigned, as the sole Holder, all of the Shares specified above); provided, however, that the parties acknowledge that the delivery of the Shares to the Holders may be delayed due to procedures and mechanics within the system of the Depository Trust Company or the New York Stock Exchange (the “NYSE”) (including the procedures and mechanics regarding the listing of the Shares on such Exchange) or other events beyond the Company’s control and that such delay will not be a default under this Agreement so long as (i) the Company is using its reasonable best efforts to effect the issuance of the Shares, and (ii) such delay is no longer than five business days.  No fractional shares will be issued in the Exchange.  All fractional shares shall be rounded up or down to the nearest whole Share.  
The second Closing (the “Second Closing”) shall occur on March 31, 2015, the date three business days following March 26, 2015, the last day of the 20 Day VWAP Period (unless otherwise extended as described above).  At the Second Closing the Company shall deliver to each Holder the portion of the Cash Payment to those specified on Exhibit A hereto (or, if there are no Accounts, the Company shall deliver to the Undersigned, as the sole Holder all of the Cash Payment specified above.  Simultaneously with or after the Closings, the Company may issue shares of Common Stock to one or more other holders of outstanding Notes or to other investors.  The cancellation of the Exchanged Notes and the delivery of the Shares shall be effected via DWAC pursuant to the instructions to be provided by Lazard Frères & Co. LLC (“Lazard”) post-pricing.  Lazard shall provide instructions to the Undersigned for settlement of the Exchange.
Article II:  Covenants, Representations and Warranties of the Holders
The Undersigned hereby covenants as follows, and makes the following representations and warranties on its own behalf and where specified below, on behalf of each Holder, each of which is and shall be true and correct on the date hereof and at each Closing, to the Company and Lazard, and all such covenants, representations and warranties shall survive each Closing.
Section 2.1    Power and Authorization.  Each of the Undersigned and the Holder is duly organized, validly existing and in good standing under the laws of its jurisdiction of formation, and the Undersigned has the power, authority and capacity to execute and deliver this Agreement, to perform its obligations hereunder, and to consummate the Exchange contemplated hereby, in each case on behalf of each Holder.  If the Undersigned is executing this Agreement on behalf of Accounts, (a) the Undersigned has all requisite discretionary and contractual authority to enter into this Agreement on behalf of, and bind, each Account, and (b) Exhibit A hereto is a true, correct and complete list of (i) the name of each Account and (ii) the principal amount of such Account’s Exchanged Notes.
Section 2.2    Valid and Enforceable Agreement; No Violations.  This Agreement has been duly executed and delivered by the Undersigned and constitutes a valid and legally binding obligation of the Undersigned and the Holder, enforceable against the Undersigned and the Holder in accordance with its terms, except that such enforcement may be subject to (a) bankruptcy, insolvency, fraudulent transfer, reorganization, moratorium or other similar laws affecting or relating to enforcement of creditors’ rights generally, and (b) general principles of equity, whether such enforceability is considered in a proceeding at law or in equity (the “Enforceability Exceptions”).  This Agreement and consummation of the Exchange will not violate, conflict with or result in a breach of or default under (i) the Undersigned’s or the Holder’s organizational documents, (ii) any agreement or instrument to which the Undersigned or the Holder is a party or by which the Undersigned or the Holder or any of their respective assets are bound, or (iii) any laws, regulations or governmental or judicial decrees, injunctions or orders applicable to the Undersigned or the Holder.

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Section 2.3    Title to the Exchanged Notes.  The Holder is the sole legal and beneficial owner of the Exchanged Notes set forth opposite its name on Exhibit A hereto (or, if there are no Accounts, the Undersigned is the sole legal and beneficial owner of all of the Exchanged Notes).  The Holder has good, valid and marketable title to its Exchanged Notes, free and clear of any Liens (other than pledges or security interests that the Holder may have created in favor of a prime broker under and in accordance with its prime brokerage agreement with such broker).  The Holder has not, in whole or in part, except as described in the preceding sentence, (a) assigned, transferred, hypothecated, pledged, exchanged or otherwise disposed of any of its rights, title or interest in or to its Exchanged Notes, or (b) given any person or entity any transfer order, power of attorney or other authority of any nature whatsoever with respect to its Exchanged Notes.  Upon the Holder’s delivery of its Exchanged Notes to the Company pursuant to the Exchange, such Exchanged Notes shall be free and clear of all Liens created by the Holder.
Section 2.4    Accredited Investor or Qualified Institutional Buyer.  The Holder is either (i) an “accredited investor” within the meaning of Rule 501 of Regulation D promulgated under the Securities Act of 1933, as amended (the “Securities Act”), or (ii) a “qualified institutional buyer” within the meaning of Rule 144A promulgated under the Securities Act; and in each case is acquiring the Shares hereunder for investment for its own respective account and not with a view to, or for resale in connection with, any distribution thereof in a manner that would violate the registration requirements of the Securities Act.
Section 2.5    No Affiliate, Related Party or 5% Stockholder Status.  The Holder is not, and has not been during the consecutive three month period preceding the date hereof, a director, officer or “affiliate” within the meaning of Rule 144 promulgated under the Securities Act (an “Affiliate”) of the Company.  To its knowledge, the Holder did not acquire any of the Exchanged Notes, directly or indirectly, from an Affiliate of the Company.  The Holder and its Affiliates collectively beneficially own and will beneficially own as of the Initial Closing Date (but without giving effect to the Exchange) (i) less than 5% of the outstanding shares of Common Stock and (ii) less than 5% of the aggregate number of votes that may be cast by holders of those outstanding securities of the Company that entitle the holders thereof to vote generally on all matters submitted to the Company's stockholders for a vote (the “Voting Power”).  The Holder is not a subsidiary, affiliate or, to its knowledge, otherwise closely-related to any director or officer of the Company or beneficial owner of 5% or more of the outstanding Common Stock or Voting Power (each such director, officer or beneficial owner, a “Related Party”).  To its knowledge, no Related Party beneficially owns 5% or more of the outstanding voting equity, or votes entitled to be cast by the outstanding voting equity, of the Holder.
Section 2.6    No Illegal Transactions.  Each of the Undersigned and the Holder has not, directly or indirectly, and no person acting on behalf of or pursuant to any understanding with it has, disclosed to a third party any information regarding the Exchange or engaged in any transactions in the securities of the Company (including, without limitation, any Short Sales (as defined below) involving any of the Company’s securities) since the time that the Undersigned was first contacted by either the Company, Lazard or any other person regarding the Exchange, this Agreement or an investment in the Shares or the Company.  Each of the Undersigned and the Holder covenants that neither it nor any person acting on its behalf or pursuant to any understanding with it will disclose to a third party any information regarding the Exchange or engage, directly or indirectly, in any transactions in the securities of the Company (including Short Sales) prior to the time the transactions contemplated by this Agreement are publicly disclosed by the Company.  “Short Sales” include, without limitation, all “short sales” as defined in Rule 200 of Regulation SHO promulgated under the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and all types of direct and indirect stock pledges, forward sale contracts, options, puts, calls, short sales, swaps, derivatives and similar arrangements (including on a total return basis), and sales and other transactions through non-U.S. broker-dealers or foreign regulated brokers.  Solely for purposes of this Section 2.6, subject to the Undersigned’s and the Holder’s compliance with their respective obligations under the U.S. federal securities laws and the Undersigned’s and the Holder’s respective internal policies, (a) “Undersigned” and “Holder” shall not be deemed to include any employees, subsidiaries, desks, groups or affiliates of the Undersigned or the Holder that are effectively walled off by appropriate “Fire Wall” information barriers approved by the Undersigned’s or 

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the Holder's respective legal or compliance department (and thus such walled off parties have not been privy to any information concerning the Exchange), and (b) the foregoing representations and covenants of this Section 2.6 shall not apply to any transaction by or on behalf of an Account, desk or group that was effected without the advice or participation of, or such Account’s, desk’s or group’s receipt of information regarding the Exchange provided by, the Undersigned or the Holder.
Section 2.7    Adequate Information; No Reliance.  The Undersigned acknowledges and agrees on behalf of itself and each Holder that (a) the Undersigned has been furnished with all materials it considers relevant to making an investment decision to enter into the Exchange and has had the opportunity to review the Company’s filings and submissions with the Securities and Exchange Commission (the “SEC”), including, without limitation, all information filed or furnished pursuant to the Exchange Act, (b) the Undersigned has had a full opportunity to ask questions of the Company concerning the Company, its business, operations, financial performance, financial condition and prospects, and the terms and conditions of the Exchange, (c) the Undersigned has had the opportunity to consult with its accounting, tax, financial and legal advisors to be able to evaluate the risks involved in the Exchange and to make an informed investment decision with respect to such Exchange, (d) neither the Company nor Lazard is acting as a fiduciary or financial or investment adviser to the Undersigned or any Holder and (e) neither the Undersigned nor any Holder is relying , and none of them has  relied, upon any statement, advice (whether accounting, tax, financial, legal or other), representation or warranty made by the Company or any of its affiliates or representatives including, without limitation, Lazard, except for (A) the publicly available filings and submissions made by the Company with the SEC under the Exchange Act and (B) the representations and warranties made by the Company in this Agreement.
Article III:  Covenants, Representations and Warranties of the Company
The Company hereby covenants as follows, and makes the following representations and warranties, each of which is and shall be true and correct on the date hereof and at each Closing, to the Holders and Lazard, and all such covenants, representations and warranties shall survive each Closing.
Section 3.1    Power and Authorization.  The Company is duly incorporated, validly existing and in good standing under the laws of its state of incorporation, and has the power, authority and capacity to execute and deliver this Agreement, to perform its obligations hereunder, and to consummate the Exchange contemplated hereby.  
Section 3.2    Valid and Enforceable Agreement; No Violations.  This Agreement has been duly executed and delivered by the Company and constitutes a valid and legally binding obligation of the Company, enforceable against the Company in accordance with its terms, except that such enforcement may be subject to the Enforceability Exceptions.  This Agreement and consummation of the Exchange will not violate, conflict with or result in a breach of or default under (i) the charter, bylaws or other organizational documents of the Company, (ii) any material agreement or instrument to which the Company is a party or by which the Company or any of its assets are bound, or (iii) any laws, regulations or governmental or judicial decrees, injunctions or orders applicable to the Company, except where such violations or conflicts would not affect the Company’s business or its ability to consummate the transactions contemplated hereby in any material respect.
Section 3.3    Valid Issuance of the Shares.  The Shares (a) are duly authorized and, upon their issuance pursuant to the Exchange against delivery of the Exchanged Notes, will be validly issued, fully paid and non-assessable, (b) will not, at the Initial Closing, be subject to any preemptive, participation, rights of first refusal or other similar rights, and (c) assuming the accuracy of each Holder’s representations and warranties hereunder, (i) will be issued in the Exchange exempt from the registration requirements of the Securities Act pursuant to Section 4(a)(2) of the Securities Act, (ii) will, at the Initial Closing, be free of any restrictions on resale by such Holder pursuant to Rule 144 promulgated under the Securities Act, and will be issued without any restrictive legends, and (iii) will be issued in compliance with all applicable state and federal laws concerning the issuance of the Shares.

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Section 3.4    Listing.  When issued in the Exchange, the Shares shall be approved for listing on the NYSE. 
Section 3.5    Disclosure.  On or before the first business day following the date of this Agreement, the Company shall issue a publicly available press release or file with the SEC a Current Report on Form 8-K disclosing all material terms of the Exchange and other non-public material matters, if any, that have been disclosed to the Undersigned by the Company or Lazard in connection with the Exchange (to the extent not previously publicly disclosed).  Without the prior written consent of the Undersigned, the Company shall not disclose the name of the Undersigned or any Holder in any filing, announcement, release or otherwise in connection with this Agreement, unless such disclosure is requested or required by applicable law, rule, regulation or legal process.
Article IV:  Miscellaneous
Section 4.1    Entire Agreement.  This Agreement and any documents and agreements executed in connection with the Exchange embody the entire agreement and understanding of the parties hereto with respect to the subject matter hereof and supersede all prior and contemporaneous oral or written agreements, representations, warranties, contracts, correspondence, conversations, memoranda and understandings between or among the parties or any of their agents, representatives or affiliates relative to such subject matter, including, without limitation, any term sheets, emails or draft documents.  
Section 4.2    Construction.  References in the singular shall include the plural, and vice versa, unless the context otherwise requires.  References in the masculine shall include the feminine and neuter, and vice versa, unless the context otherwise requires.  Headings in this Agreement are for convenience of reference only and shall not limit or otherwise affect the meanings of the provisions hereof.  Neither party, nor its respective counsel, shall be deemed the drafter of this Agreement for purposes of construing the provisions of this Agreement, and all language in all parts of this Agreement shall be construed in accordance with its fair meaning, and not strictly for or against either party.
Section 4.3    Governing Law.  This Agreement shall in all respects be construed in accordance with and governed by the substantive laws of the State of New York, without reference to its choice of law rules.
Section 4.4    Counterparts.  This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same instrument.  Any counterpart or other signature hereon delivered by facsimile or any standard form of telecommunication or e-mail shall be deemed for all purposes as constituting good and valid execution and delivery of this Agreement by such party.
Section 4.5    Third Party Beneficiaries.  This Agreement is also intended for the immediate benefit of Lazard.  Lazard may rely on the provisions of this Agreement, including, but not limited to, the respective covenants, representations and warranties of the Undersigned, the Holders and the Company.
[Signature Page Follows]

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IN WITNESS WHEREOF, each of the parties hereto has caused this Agreement to be executed as of the date first above written.

	
		
	“UNDERSIGNED”:  
_______________________________________
(in its capacities described in the first paragraph hereof)
By: _________________________________
Name: _______________________________ 
Title: ________________________________
	“COMPANY”:  
________________________________
By: _________________________________
Name: _______________________________ 
Title: ________________________________

Signature Page to Exchange Agreement  
Forest City Enterprises, Inc.

EXHIBIT A 
Exchanging Beneficial Owners

	
		
	Name of Beneficial Owner
	Principal Amount of Exchanged NotesEX-10.12

 Exhibit 10.12 

AMERISAFE, INC. 
 2012
EQUITY AND INCENTIVE COMPENSATION PLAN 
 LONG-TERM INCENTIVE AWARD AGREEMENT 

THIS LONG-TERM INCENTIVE AWARD AGREEMENT (this “Agreement”), dated as of
            , 2014 (the “Grant Date”), is entered into by and between AMERISAFE, Inc., a Texas corporation (the “Company”), and
            (the “Grantee”). Where the context permits, references to the Company shall include any successor to the Company. Any capitalized term that is used, but not defined,
in this Agreement shall have the meaning assigned to such term in the AMERISAFE, Inc. 2012 Equity and Incentive Compensation Plan (as amended from time to time, the “Plan”). 

1. Grant of Long-Term Incentive Award. The Company hereby grants to the Grantee, effective as of the Grant Date, a long-term incentive
award (the “Long-Term Incentive Award”) with a target value of             (the “Target Award”), subject to all of the terms and conditions of this Agreement and the
Plan. The actual amount, if any, to be paid to the Grantee in respect of the Long-Term Incentive Award will be determined and certified by the Committee pursuant to the terms of this Agreement and Exhibit A hereto; provided, however,
that the Committee shall have the right in it sole discretion to reduce the amount of the Long-Term Incentive Award determined in accordance with Exhibit A hereto. 

2. Performance Period. The Performance Period applicable to the Long-Term Incentive Award shall be the period set forth on Annex 1 to
Exhibit A hereto. 
 3. Vesting and Payment of Long-Term Incentive Award. The Long-Term Incentive Award will be subject to the
following vesting provisions: 
 (a) Normal Vesting and Payment. Subject to the terms of Sections 3(b) and 3(c), if the Grantee
remains employed by the Company or a Subsidiary through the end of the Performance Period, the Grantee will be entitled to receive an amount in full satisfaction of the Long-Term Incentive Award equal to the product of (i) the Target Award and
(ii) the Total Multiplier (as defined on Exhibit A) (such amount, the “Award Amount”), payable as set forth in Section 3(e). 

(b) Vesting and Payment Upon Certain Terminations. Notwithstanding anything set forth in Section 3(a) to the contrary, if the
Grantee’s employment with the Company and its Subsidiaries terminates prior to the end of the Performance Period as a result of the Grantee’s death, Disability or Retirement, then the Grantee (or the Grantee’s beneficiary, if
applicable) will be entitled to receive an amount in full satisfaction of the Long-Term Incentive Award, payable on the Payment Date, equal to the product of (i) the Award Amount determined pursuant to Exhibit A and (ii) the applicable
percentage set forth in the table below (the “Applicable Termination Percentage”), provided that as of the Payment Date, the Grantee is and has since the Grant Date been in compliance with all Company policies applicable to the Grantee and
all of the Grantee’s obligations under any agreements between the Company or a Subsidiary, on the one hand, and the Grantee, on the other hand. 

					
	Date of Termination	  	Applicable
Termination
Percentage	 
		
	 Within six months of the commencement of the Performance Period
	  	 	0	% 
		
	 After six months following commencement of the Performance Period but within 18 months of the commencement of the Performance
Period
	  	 	33 1/3	% 
		
	 After 18 months following commencement of the Performance Period but within 30 months of the commencement of the Performance
Period
	  	 	66 2/3	% 
		
	 After 30 months following the commencement of the Performance Period
	  	 	100	% 

 (c) Vesting Following Change in Control. Notwithstanding anything set forth in this Agreement to the
contrary, if a Change in Control occurs prior to the earlier of (i) the Payment Date and (ii) the forfeiture of the Long-Term Incentive Award pursuant to Section 3(d), then the Long-Term Incentive Award shall continue in accordance
with its terms; provided, however, that if the Grantee’s employment with the Company and its Subsidiaries is terminated subsequent to a Change in Control but prior to the end of the Performance Period either (x) by the
Company without Cause or (y) by the Grantee for Good Reason, then the Grantee will be entitled to receive an amount in full satisfaction of the Long-Term Incentive Award, payable on the Payment Date, equal to the product of (A) the Award
Amount determined pursuant to Exhibit A and (B) the Applicable Termination Percentage set forth in Section 3(b) above. 
 (d)
Forfeiture. Upon the termination of the Grantee’s employment with the Company and its Subsidiaries prior to the end of the Performance Period for any reason other than those specified in Sections 3(b) or 3(c), the Long-Term Incentive
Award shall be forfeited, and neither the Company nor any Subsidiary shall have any obligation to make any payment to the Grantee in respect of the Long-Term Incentive Award. 

(e) Payment of Long-Term Incentive Award. The Long-Term Incentive Award shall be paid to the Grantee (or the Grantee’s
beneficiary, if applicable) in a number of Common Shares (rounded up or down to the nearest whole Common Share) equal to (i) the amount, if any, of the Long-Term Incentive Award determined pursuant to the applicable subsection of this
Agreement, divided by (ii) the Value per Share, payable as soon as practicable following the end of the Performance Period, provided that in no event shall any such delivery occur later than the first anniversary of the final day of the
Performance Period (such date on which payment of the Long-Term Incentive Award is made, the “Payment Date”). As used in this Agreement, “Value per Share” means the volume weighted trading price per Share for the 10 trading days
immediately preceding the date the Award Amount is approved by the Committee. In the event that the number of Common Shares issuable on any Payment date would result in the Company issuing a greater number of Common Shares than permitted under the
Plan, the Committee may authorize all or a portion of the Long-Term Incentive Award to be paid in cash. 

  
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 (f) Definition of Disability. For purposes of this Agreement, “Disability” means
that the Grantee (i) is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or can be expected to last for a continuous period of
not less than 12 months, or (ii) is, by reason of any medically determinable physical or mental impairment which can be expected to result in death or can be expected to last for a continuous period of not less than 12 months, receiving income
replacement benefits for a period of not less than three months under an accident and health plan, or disability plan, covering employees of the Company or a Subsidiary. 

(g) Definition of Retirement. For purposes of this Agreement, “Retirement” means a voluntary termination of the
Grantee’s employment for any reason more than 179 days after the Grant Date; provided, that as of the date of such termination, the Grantee: (i) has at least ten years of service as an employee of the Company or a Subsidiary;
(ii) has attained the age of 60; and (iii) has not, as of the Payment Date, obtained substantial employment or service as a consultant to any person or entity (other than with the Company or its Subsidiaries) engaged in the business of the
Company or its Subsidiaries. 
 4. Withholding Taxes. To the extent that the Company is required to withhold federal, state, local or
foreign taxes in connection with the delivery of Common Shares to the Grantee or any other person under this Agreement, the number of Common Shares to be delivered to the Grantee or such other person may be reduced (based on the Market Value per
Share as of the date the Common Shares become payable), if so permitted by the Committee, to provide for the taxes required to be withheld, with any fractional shares that would otherwise be delivered being rounded up to the next nearest whole
share. In no event, however, shall the Company accept Common Shares for payment of taxes in excess of required tax withholding rates. The Committee may, at its discretion, adopt any alternative method of providing for taxes to be withheld.
Notwithstanding the foregoing, in no event shall the Company be required to withhold or accept Common Shares for payment of any taxes if, in the good faith determination of the Committee, such withholding or acceptance of Common Shares may result in
breach of the terms of an agreement that is currently in effect and to which the Company is a party. 
 5. Governing Law. This
Agreement is made under, and shall be construed in accordance with, the internal substantive laws of the State of Texas. 
 6.
Amendments. Any amendment to the Plan is deemed to be an amendment to this Agreement to the extent that the amendment is applicable hereto; provided, however, that no amendment may impair the rights of the Grantee with respect
to the Long-Term Incentive Award unless agreed to by the Grantee and the Company, which agreement must be in writing and signed by the Grantee and the Company. 

  
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 7. Notices. All notices, requests, consents and other communications required or provided
under this Agreement to be delivered by the Grantee to the Company will be in writing and will be deemed sufficient if delivered by hand, nationally recognized overnight courier, or certified or registered mail, return receipt requested, postage
prepaid, and will be effective upon delivery to the Company at the address set forth below: 
 AMERISAFE, Inc. 

2301 Hwy 190 West 
 DeRidder, LA
70634 
 Attention: General Counsel 
 All
notices, requests, consents and other communications required or provided under this Agreement to be delivered by the Company to the Grantee may be delivered by e-mail or in writing and will be deemed sufficient if delivered by e-mail, hand,
facsimile, nationally recognized overnight courier, or certified or registered mail, return receipt requested, postage prepaid, and will be effective upon delivery to the Grantee. 

8. Recoupment. This Agreement will be administered in compliance with Section 10D of the Exchange Act, and any applicable rules or
regulations promulgated by the Securities and Exchange Commission or any national securities exchange or national securities association on which the Common Shares may be traded. In its discretion (including the discretion provided to the Committee
pursuant to the proviso included in Section 1 hereof), the Committee may require repayment to the Company of all or any portion of the Long-Term Incentive Award (a) (i) if the amount paid was calculated based upon the achievement of
Performance Factors (as defined in Exhibit A hereto) that were subsequently affected as a result of a restatement of the Company’s statutory financial statements and (ii) the amount payable to the Grantee would have been lower than the
amount actually paid to the Grantee, or (b) in the event of a restatement of the Company’s financial statements filed with the Securities and Exchange Commission. This discretionary authority of the Committee under this Section 8 is
not conditioned on the Grantee having engaged in misconduct that caused or contributed to the need for any such restatement. This Section 8 is not the Company’s exclusive remedy with respect to such matters. 

9. Severability. In the event that one or more of the provisions of this Agreement is invalidated for any reason by a court of
competent jurisdiction, any provision so invalidated will be deemed to be separable from the other provisions of this Agreement, and the remaining provisions of this Agreement will continue to be valid and fully enforceable. 

10. Right to Terminate Employment. No provision of this Agreement will limit in any way whatsoever any right that the Company or a
Subsidiary may otherwise have to terminate the employment of the Grantee at any time. 
 11. Relation to Other Benefits. Any economic
or other benefit to the Grantee under this Agreement or the Plan will not be taken into account in determining any benefits to which the Grantee may be entitled under any profit sharing, retirement or other benefit or compensation plan maintained by
the Company or a Subsidiary and will not affect the amount of any life insurance coverage available to any beneficiary under any life insurance plan covering employees of the Company or a Subsidiary. 

12. Interpretation. The interpretation and construction of this Agreement by the Board shall be final and conclusive. No member of the
Board shall be liable for any such action or determination made in good faith. 

  
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 13. Integration. The Long-Term Incentive Award is granted pursuant to the Plan.
Notwithstanding anything in this Agreement to the contrary, this Agreement is subject to all of the terms and conditions of the Plan, which is incorporated herein by reference. As such, this Agreement and the Plan embody the entire agreement and
understanding of the Company and the Grantee and supersede any prior understandings or agreements, whether written or oral, with respect to the Long-Term Incentive Award. 

14. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed to be an original and all of
which together shall be deemed to be one and the same instrument. 
 [SIGNATURE PAGE FOLLOWS] 

  
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 IN WITNESS WHEREOF, the Company has caused this Agreement to be duly executed and delivered by a
duly authorized officer, and the Grantee has duly executed and delivered this Agreement, as of the date first written above. 
  

			
	AMERISAFE, INC.
		
	By:		  

	Name:		C. Allen Bradley, Jr.
	Title:		Chief Executive Officer
	
	GRANTEE

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00241-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00241-of-00352.parquet"}]]