Document:

Form of Medium-Term Notes

 Exhibit 4.1 
 [Face of Note] 
 Unless this certificate is presented by an authorized
representative of The Depository Trust Company, a New York corporation (“DTC”), to the Company or its agent for registration of transfer, exchange or payment, and any certificate issued is registered in the name of Cede &
Co. or in such other name as requested by an authorized representative of DTC (and any payment is made to Cede & Co. or such other entity as is requested by an authorized representative of DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR
VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the registered owner hereof, Cede & Co., has an interest herein. 
  

			
	CUSIP NO. 94986RFF3	  	FACE AMOUNT: $            
	REGISTERED NO.     	  	

 WELLS FARGO & COMPANY 

MEDIUM-TERM NOTE, SERIES K 
 Due Nine Months or More From Date of Issue 
 Notes Linked to a Global ETF
Basket 
 due February 22, 2016 
 WELLS FARGO & COMPANY, a corporation duly organized and existing under the laws of the State of Delaware (hereinafter called the “Company,” which term includes any successor
corporation under the Indenture hereinafter referred to), for value received, hereby promises to pay to CEDE & Co., or registered assigns, an amount equal to the Redemption Amount (as defined below), in such coin or currency of the United
States of America as at the time of payment is legal tender for payment of public and private debts, on the Stated Maturity Date. The “Initial Stated Maturity Date” shall be February 22, 2016. If no Market Disruption Event (as
defined below) occurs or is continuing with respect to a Basket Component (as defined below) on the scheduled Calculation Day (as defined below), the Initial Stated Maturity Date will be the “Stated Maturity Date.” If a Market
Disruption Event occurs or is continuing with respect to a Basket Component on the scheduled Calculation Day, the “Stated Maturity Date” shall be the later of (i) three Business Days (as defined below) after the postponed
Calculation Day with respect to such Basket Component (or, if the Calculation Day is postponed with respect to more than one Basket Component, three Business Days after the latest postponed Calculation Day) and (ii) the Initial Stated Maturity
Date. This Security shall not bear any interest. 
 Any payments on this Security at Maturity will be made against presentation
of this Security at the office or agency of the Company maintained for that purpose in the City of Minneapolis, Minnesota and at any other office or agency maintained by the Company for such purpose. 

 “Face Amount” shall mean, when used with respect to this Security, the
amount set forth on the face of this Security as its “Face Amount.” 
 Determination of Redemption Amount 

The “Redemption Amount” of this Security will equal: 

 

	 	•	 	 If the Ending Price is greater than the Starting Price: the lesser of: 

 

	 	(i)	the Face Amount plus: 

  

																			
		  	[	  	Face Amount x	  	[	  	 Ending Price – Starting Price

Starting Price
	  	]	 	x Participation Rate	  	]	  	; and	 	
	  	  	  	  	  	 	  	  	 

  

	 	(ii)	the Capped Value; 

  

	 	•	 	 If the Ending Price is less than or equal to the Starting Price, but greater than or equal to the Threshold Price: the Face Amount; or

  

	 	•	 	 If the Ending Price is less than the Threshold Price: the Face Amount minus: 

 

											
		 	[	 	Face Amount x	  	 Starting Price – Ending Price

Starting Price
	  	]	 	
		 	 	  	  	 

 “Basket” shall mean a basket comprised of the following Basket Components, with the
return of each Basket Component having the weighting noted parenthetically: SPDR S&P 500 ETF Trust (45%); iShares Russell 2000 Index Fund (20%); iShares MSCI EAFE Index Fund (20%); and iShares MSCI Emerging Markets Index Fund (15%). 

“Basket Component” shall mean each of the SPDR S&P 500 ETF Trust, iShares Russell 2000 Index Fund, iShares MSCI EAFE
Index Fund, and iShares MSCI Emerging Markets Index Fund. 
 “Underlying Index” shall mean each of the S&P
500 Index, the Russell 2000 Index, the MSCI EAFE Index, and the MSCI Emerging Markets Index. 
 The “Pricing
Date” shall mean August 12, 2011. 
 The “Starting Price” is 100. 

The “Ending Price” will be calculated based on the weighted returns of the Basket Components and will be equal to the
product of (i) 100 and (ii) an amount equal to 1 plus the sum of: (A) 45% of the Component Return of the SPDR S&P 500 ETF Trust; (B) 20% of the Component Return of the iShares Russell 2000 Index Fund; (C) 20% of the
Component Return of the iShares MSCI EAFE Index Fund; and (D) 15% of the Component Return of the iShares MSCI Emerging Markets Index Fund. 

  
 2 

 The “Component Return” of a Basket Component will be equal to: 

Final Component Price – Initial Component Price 
 Initial Component Price 
 where, 

 

	 	•	 	 the “Initial Component Price” is the Fund Closing Price of such Basket Component on the Pricing Date; and

  

	 	•	 	 the “Final Component Price” will be the Fund Closing Price of such Basket Component on the Calculation Day.

 The Initial Component Prices of the Basket Components are as follows: SPDR S&P 500 ETF Trust ($118.15);
iShares Russell 2000 Index Fund ($69.78); iShares MSCI EAFE Index Fund ($52.91); and iShares MSCI Emerging Markets Index Fund ($41.26). 
 The “Fund Closing Price,” with respect to a Basket Component on any Trading Day, means the product of (i) the Closing Price of one share of such Basket Component (or one unit of any
other security for which a Fund Closing Price must be determined) on such Trading Day and (ii) the Adjustment Factor applicable to such Basket Component on such Trading Day. 

The “Closing Price” with respect to a share of a Basket Component (or one unit of any other security for which a Closing
Price must be determined) on any Trading Day means the price, at the scheduled weekday closing time, without regard to after hours or any other trading outside the regular trading session hours, of the share on the principal United States securities
exchange registered under the Securities Exchange Act of 1934, as amended, on which the share (or any such other security) is listed or admitted to trading. 
 The “Adjustment Factor” means, with respect to a share of a Basket Component (or one unit of any other security for which a Fund Closing Price must be determined), 1.0, subject to
adjustment in the event of certain events affecting the shares of such Basket Component. See “Anti-dilution Adjustments Relating To A Basket Component; Alternate Calculation—Anti-dilution Adjustments.” 

The “Capped Value” is 168% of the Face Amount of this Security. 

The “Threshold Price” is equal to 60% of the Starting Price. 

The “Participation Rate” is 150%. 

  
 3 

 “Business Day” shall mean a day, other than a Saturday or Sunday, that is
neither a legal holiday nor a day on which banking institutions are authorized or required by law or regulation to close in New York, New York or Minneapolis, Minnesota. 
 A “Trading Day” with respect to a Basket Component means a day, as determined by the Calculation Agent, on which (i) the Relevant Exchange (as defined below) with respect to such
Basket Component is open for trading for its regular trading session and (ii) the Relevant Exchange on which futures or options contracts related to such Basket Component or any successor thereto, if applicable, are traded, are open for trading
for their respective regular trading sessions. 
 The “Calculation Day” shall be February 12, 2016 or, if
such day is not a Trading Day, the next succeeding Trading Day. The Calculation Day is subject to postponement due to the occurrence of a Market Disruption Event. If a Market Disruption Event occurs or is continuing with respect to a Basket
Component on the Calculation Day, such Calculation Day for such Basket Component will be postponed to the first succeeding Trading Day on which a Market Disruption Event for such Basket Component has not occurred and is not continuing. If such first
succeeding Trading Day has not occurred as of the eighth scheduled Trading Day after the scheduled Calculation Day for such Basket Component, that eighth scheduled Trading Day shall be deemed the Calculation Day. If the Calculation Day has been
postponed eight scheduled Trading Days after the scheduled Calculation Day for such Basket Component and such eighth scheduled Trading Day is not a Trading Day, or if a Market Disruption Event occurs or is continuing with respect to the Basket
Component on such eighth scheduled Trading Day, the Calculation Agent will determine its good faith estimate of the Closing Price of such Basket Component on such eighth scheduled Trading Day. Notwithstanding a postponement of a Calculation Day for
a particular Basket Component due to a Market Disruption Event with respect to such Basket Component, the originally scheduled Calculation Day will remain the Calculation Day for any Basket Component not affected by a Market Disruption Event. See
“—Market Disruption Events.” 
 “Calculation Agent Agreement” shall mean the Calculation Agent
Agreement dated as of August 19, 2011 between the Company and the Calculation Agent, as amended from time to time. 

“Calculation Agent” shall mean the Person that has entered into the Calculation Agent Agreement with the Company
providing for, among other things, the determination of the Ending Price and the Redemption Amount, which term shall, unless the context otherwise requires, include its successors under such Calculation Agent Agreement. The initial Calculation Agent
shall be Wells Fargo Securities, LLC. Pursuant to the Calculation Agent Agreement, the Company may appoint a different Calculation Agent from time to time after the initial issuance of this Security without the consent of the Holder of this Security
and without notifying the Holder of this Security. 

  
 4 

 Market Disruption Events 

A “Market Disruption Event” means, with respect to a Basket Component, any of the following events as determined by the
Calculation Agent in its sole discretion: 
  

	 	(A)	A material suspension or material limitation of trading or the unavailability of the Closing Price of the shares of such Basket Component or any Successor Fund (as
defined below under “Anti-dilution Adjustments Relating To A Basket Component; Alternate Calculation—Liquidation Events”) has been imposed by the Relevant Exchange on which such shares are traded, at any time during the one-hour
period preceding the Close of Trading on such day, whether by reason of movements in price exceeding limits permitted by such Relevant Exchange or otherwise. 

 

	 	(B)	A material suspension or material limitation of trading has occurred on that day, in each case during the one-hour period preceding the Close of Trading in options or
futures contracts related to such Basket Component or any Successor Fund on the Relevant Exchange on which those options or futures contracts are traded, whether by reason of movements in price exceeding levels permitted by the Relevant Exchange, or
otherwise. 

  

	 	(C)	Any event, other than an early closure, that materially disrupts or impairs the ability of market participants in general to effect transactions in, or obtain market
values for, the shares of such Basket Component or any Successor Fund at any time during the one-hour period that precedes the Close of Trading on that day. 

 

	 	(D)	Any event, other than an early closure, that materially disrupts or impairs the ability of market participants in general to effect transactions in, or obtain market
values for, the futures or options contracts relating to such Basket Component or any Successor Fund on the Relevant Exchange on which those futures or options contracts are traded, at any time during the one-hour period that precedes the Close of
Trading on that day. 

  

	 	(E)	The closure of the Relevant Exchange on which the shares of such Basket Component or any Successor Fund or the Relevant Exchange on which futures or options contracts
relating to such Basket Component or any Successor Fund are traded prior to its scheduled Close of Trading unless the earlier closing time is announced by such Relevant Exchange at least one hour prior to the earlier of (1) the actual closing
time for the regular trading session on such Relevant Exchange and (2) the submission deadline for orders to be entered into such Relevant Exchange for execution at the Close of Trading on that day. 

For purposes of determining whether a Market Disruption Event has occurred: 

 

	 	(1)	“Close of Trading” means in respect of any Relevant Exchange, the scheduled weekday closing time on a day on which such Relevant Exchange is scheduled
to be open for trading for its respective regular trading session, without regard to after hours or any other trading outside the regular trading session hours; and 

  
 5 

	 	(2)	“Relevant Exchange” for any share, option or option contract means the primary exchange or quotation system on which such share, option or option
contract is traded, as determined by the Calculation Agent. 

 Anti-dilution Adjustments Relating To A Basket Component;
Alternate Calculation 
 Anti-dilution Adjustments 

The Calculation Agent, in its sole discretion, may adjust the Adjustment Factor as a result of certain events related to a Basket
Component or any Successor Fund, as applicable, which occur during the term of this Security. Such events include, but are not limited to, the following: 
  

	 	(A)	Stock Splits and Reverse Stock Splits  

 If a stock split or reverse stock split has occurred, then once such split has become effective, the Adjustment Factor will be adjusted to equal the product of the prior Adjustment Factor and the number
of securities which a holder of one share (or other applicable security) of such Basket Component before the effective date of such stock split or reverse stock split would have owned or been entitled to receive immediately following the applicable
effective date. 
  

	 	(B)	Stock Dividends  

 If a
(i) stock dividend (i.e., issuance of additional shares (or other applicable security) by a Basket Component) that is given ratably to all holders of record of shares (or other applicable security) of a Basket Component or
(ii) distribution of shares (or other applicable security) of a Basket Component has occurred, then once the dividend has become effective and the shares (or other applicable security) of such Basket Component are trading ex-dividend, the
Adjustment Factor will be adjusted on the ex-dividend date to equal the prior Adjustment Factor plus the product of the prior Adjustment Factor and the number of shares (or other applicable security) of such Basket Component which a holder of one
share (or other applicable security) of such Basket Component before the date the dividend became effective and the shares (or other applicable security) of such Basket Component traded ex-dividend would have owned or been entitled to receive
immediately following that date; provided, however, that no adjustment will be made for a distribution for which the number of securities of such Basket Component paid or distributed is based on a fixed cash equivalent value, unless such
distribution is an Extraordinary Dividend as defined and discussed below. 

  
 6 

	 	(C)	Extraordinary Dividends  

If an Extraordinary Dividend (as defined below) has occurred, then on the ex-dividend date, the Adjustment Factor will be adjusted to
equal the product of the prior Adjustment Factor and a fraction, the numerator of which is the Closing Price per share (or other applicable security) of such Basket Component on the Trading Day preceding the ex-dividend date, and the denominator of
which is the amount by which the Closing Price per share (or other applicable security) of such Basket Component on the Trading Day preceding the ex-dividend date exceeds the Extraordinary Dividend Amount (as defined below). 

For purposes of determining whether an Extraordinary Dividend has occurred: 

 

	 	(1)	“Extraordinary Dividend” means, with respect to a cash dividend or other distribution with respect to the shares (or other applicable security) of such
Basket Component, a dividend or other distribution which exceeds the immediately preceding non-Extraordinary Dividend on the securities of such Basket Component (as adjusted for any subsequent corporate event requiring an adjustment hereunder, such
as a stock split or reverse stock split) by an amount equal to at least 10% of the Closing Price of such Basket Component on the Trading Day preceding the ex-dividend date with respect to the Extraordinary Dividend (the “ex-dividend
date”); and 

  

	 	(2)	“Extraordinary Dividend Amount” with respect to an Extraordinary Dividend for the securities of such Basket Component will equal:

  

	 	•	 	 in the case of cash dividends or other distributions that constitute regular dividends, the amount per share (or other applicable security) of such
Basket Component of that Extraordinary Dividend minus the amount per share (or other applicable security) of the immediately preceding non-Extraordinary Dividend for that share (or other applicable security) of such Basket Component; or

  

	 	•	 	 in the case of cash dividends or other distributions that do not constitute regular dividends, the amount per share (or other applicable security) of
such Basket Component of that Extraordinary Dividend. 

 To the extent an Extraordinary Dividend is not paid in
cash, the value of the non-cash component will be determined by the Calculation Agent. A distribution on the securities of such Basket Component described below under the sections entitled “—Other Distributions” and
“—Reorganization Events” below that also constitute an Extraordinary Dividend will only cause an adjustment pursuant to those sections. 

  
 7 

	 	(D)	Other Distributions  

 If
a Basket Component declares or makes a distribution to all holders of the shares (or other applicable security) of such Basket Component of any class of its capital stock, evidences of its indebtedness or other non-cash assets, including, but not
limited to, transferable rights and warrants, then, in each of these cases, the Adjustment Factor will equal the product of the prior Adjustment Factor and a fraction, the numerator of which will be the Closing Price per share (or other applicable
security) of such Basket Component, and the denominator of which will be the Closing Price per share (or other applicable security) of such Basket Component, less the fair market value, as determined by the Calculation Agent, as of the time the
adjustment is effected of the portion of the capital shares, assets, evidences of indebtedness, rights or warrants so distributed or issued applicable to one share (or other applicable security) of such Basket Component. 

 

	 	(E)	Reorganization Events  

If a Basket Component, or any Successor Fund, is subject to a merger, combination, consolidation or statutory exchange of securities with
another exchange traded fund, and such Basket Component is not the surviving entity, then, on or after the date of such event, the Calculation Agent shall, in its sole discretion, make an adjustment to the Adjustment Factor or the method of
determining the Redemption Amount or any other terms of this Security as the Calculation Agent determines appropriate to account for the economic effect on this Security of such event (including adjustments to account for changes in volatility,
expected dividends, stock loan rate or liquidity relevant to this Security), and determine the effective date of that adjustment. If the Calculation Agent determines that no adjustment that it could make will produce a commercially reasonable
result, then the Calculation Agent may deem such event a Liquidation Event (as defined below). 
 Liquidation Events

 If a Basket Component is de-listed, liquidated or otherwise terminated (a “Liquidation Event”), and a
successor or substitute exchange traded fund exists that the Calculation Agent determines, in its sole discretion, to be comparable to such Basket Component, then, upon the Calculation Agent’s notification of that determination to the Trustee
and the Company, any subsequent Fund Closing Price for such Basket Component will be determined by reference to the Fund Closing Price of such successor or substitute exchange traded fund (such exchange traded fund being referred to herein as a
“Successor Fund”). 
 Upon any selection by the Calculation Agent of a Successor Fund, the Company will cause
notice to be given to Holder of this Security. 
 If a Basket Component undergoes a Liquidation Event prior to, and such
Liquidation Event is continuing on, the date that the Fund Closing Price of such Basket Component is to be 

  
 8 

 
determined and the Calculation Agent determines that no Successor Fund is available at such time, then the Calculation Agent will, in its discretion, calculate the Fund Closing Price for such
Basket Component on such date by a computation methodology that the Calculation Agent determines will as closely as reasonably possible replicate such Basket Component. 
 If a Successor Fund is selected or the Calculation Agent calculates the Fund Closing Price as a substitute for a Basket Component, such Successor Fund or Fund Closing Price will be used as a substitute
for such Basket Component for all purposes, including for purposes of determining whether a Market Disruption Event exists. 

If at any time the method of calculating a Basket Component or a Successor Fund, or the related Underlying Index, is changed in a
material respect, or if a Basket Component or a Successor Fund is in any other way modified so that such Basket Component does not, in the opinion of the Calculation Agent, fairly represent the price of the securities of such Basket Component or
such Successor Fund had such changes or modifications not been made, then the Calculation Agent will, at the close of business in New York City on the date that the Fund Closing Price is to be determined, make such calculations and adjustments as,
in the good faith judgment of the Calculation Agent, may be necessary in order to arrive at a Closing Price of an exchange traded fund comparable to such Basket Component or Successor Fund, as the case may be, as if such changes or modifications had
not been made, and calculate the Fund Closing Price and the Redemption Amount with reference to such adjusted Closing Price of such Basket Component or such Successor Fund, as applicable. 
 Calculation Agent 
 The Calculation Agent will determine the
Redemption Amount and the Ending Price. In addition, the Calculation Agent will (i) determine if adjustments are required to the Fund Closing Price and/or the Adjustment Factor of a Basket Component under the circumstances described in this
Security, (ii) if a Basket Component undergoes a Liquidation Event, select a Successor Fund or, if no Successor Fund is available, determine the Fund Closing Price of such Basket Component, and (iii) determine whether a Market Disruption
Event has occurred. 
 The Company covenants that, so long as this Security is Outstanding, there shall at all times be a
Calculation Agent (which shall be a broker-dealer, bank or other financial institution) with respect to this Security. 
 All
determinations made by the Calculation Agent with respect to this Security will be at the sole discretion of the Calculation Agent and, in the absence of manifest error, will be conclusive for all purposes and binding on the Company and the Holder
of this Security. All percentages and other amounts resulting from any calculation with respect to this Security will be rounded at the Calculation Agent’s discretion. 
 Tax Considerations 
 The Company agrees, and by acceptance of a
beneficial ownership interest in this Security each Holder of this Security will be deemed to have agreed (in the absence of a statutory, regulatory, administrative or judicial ruling to the contrary), for United States federal income tax purposes
to characterize and treat this Security as a pre-paid derivative contract in respect of the Basket. 

  
 9 

 Redemption and Repayment 

This Security is not subject to redemption at the option of the Company or repayment at the option of the Holder hereof prior to
February 22, 2016. This Security is not entitled to any sinking fund. 
 Acceleration 

If an Event of Default, as defined in the Indenture, with respect to this Security shall occur and be continuing, the Redemption Amount
(calculated as set forth in the next sentence) of this Security may be declared due and payable in the manner and with the effect provided in the Indenture. The amount payable to the Holder hereof upon any acceleration permitted under the Indenture
will be equal to the Redemption Amount hereof calculated as provided herein as though the date of acceleration was the Calculation Day; provided, however, if such date is not a Trading Day or if a Market Disruption Event has occurred or is
continuing on that day, the Calculation Day will be postponed as provided herein. 
  

 
 Reference is
hereby made to the further provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect as if set forth at this place. 

Unless the certificate of authentication hereon has been executed by the Trustee referred to on the reverse hereof by manual signature or
its duly authorized agent under the Indenture referred to on the reverse hereof by manual signature, this Security shall not be entitled to any benefit under the Indenture or be valid or obligatory for any purpose. 

[The remainder of this page has been left intentionally blank] 

  
 10 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed under its
corporate seal. 
 DATED: 
  

					
		 	WELLS FARGO & COMPANY
			
		 	By:	 	  

			
		 		 	Its:
	[SEAL]	 		 	
			
		 	Attest:	 	  

			
		 		 	Its:

 TRUSTEE’S CERTIFICATE OF 
 AUTHENTICATION 
 This is one of the Securities of the 

series designated therein described 
 in the
within-mentioned Indenture. 
  

			
	 CITIBANK, N.A.,
 as Trustee

		
	By:	 	  

		 	Authorized Signature
		
		 	OR
	
	 WELLS FARGO BANK, N.A., as
   Authenticating Agent for the Trustee

		
	By:	 	  

		 	Authorized Signature

  
 11 

 [Reverse of Note] 
 WELLS FARGO & COMPANY 
 MEDIUM-TERM NOTE, SERIES K

 Due Nine Months or More From Date of Issue 
 Notes Linked to a Global ETF Basket 
 due February 22, 2016

 This Security is one of a duly authorized issue of securities of the Company (herein called the
“Securities”), issued and to be issued in one or more series under an indenture dated as of July 21, 1999, as amended or supplemented from time to time (herein called the “Indenture”), between the Company and
Citibank, N.A., as Trustee (herein called the “Trustee,” which term includes any successor trustee under the Indenture), to which Indenture and all indentures supplemental thereto reference is hereby made for a statement of the
respective rights, limitations of rights, duties and immunities thereunder of the Company, the Trustee and the Holders of the Securities, and of the terms upon which the Securities are, and are to be, authenticated and delivered. This Security is
one of the series of the Securities designated as Medium-Term Notes, Series K, of the Company, which series is limited to an aggregate principal amount or face amount, as applicable, of $25,000,000,000 or the equivalent thereof in one or more
foreign or composite currencies. The amount payable on the Securities of this series may be determined by reference to the performance of one or more equity-, commodity- or currency-based indices, exchange traded funds, securities, commodities,
currencies, statistical measures of economic or financial performance, or a basket comprised of two or more of the foregoing, or any other market measure or may bear interest at a fixed rate or a floating rate. The Securities of this series may
mature at different times, be redeemable at different times or not at all, be repayable at the option of the Holder at different times or not at all and be denominated in different currencies. 

Article Sixteen of the Indenture shall not apply to this Security. 

The Securities are issuable only in registered form without coupons and will be either (a) book-entry securities represented by one
or more Global Securities recorded in the book-entry system maintained by the Depositary or (b) certificated securities issued to and registered in the names of, the beneficial owners or their nominees. 

The Company agrees, to the extent permitted by law, not to voluntarily claim the benefits of any laws concerning usurious rates of
interest against a Holder of this Security. 
 Modification and Waivers 

The Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification of the rights and
obligations of the Company and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the Company and the Trustee with the consent of the Holders of a majority in principal amount of the
Securities at the 

  
 12 

 
time Outstanding of all series to be affected, acting together as a class. The Indenture also contains provisions permitting the Holders of a majority in principal amount of the Securities of all
series at the time Outstanding affected by certain provisions of the Indenture, acting together as a class, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with those provisions of the Indenture. Certain
past defaults under the Indenture and their consequences may be waived under the Indenture by the Holders of a majority in principal amount of the Securities of each series at the time Outstanding, on behalf of the Holders of all Securities of such
series. Solely for the purpose of determining whether any consent, waiver, notice or other action or Act to be taken or given by the Holders of Securities pursuant to the Indenture has been given or taken by the Holders of Outstanding Securities in
the requisite aggregate principal amount, the principal amount of this Security will be deemed to be equal to the amount set forth on the face hereof as the “Face Amount” hereof. Any such consent or waiver by the Holder of this Security
shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or
waiver is made upon this Security. 
 Defeasance 
 Section 403 and Article Fifteen of the Indenture and the provisions of clause (ii) of Section 401(1)(B) of the Indenture, relating to defeasance at any time of (a) the entire
indebtedness on this Security and (b) certain restrictive covenants and certain Events of Default, upon compliance by the Company with certain conditions set forth therein, shall not apply to this Security. The remaining provisions of
Section 401 of the Indenture shall apply to this Security. 
 Authorized Denominations 

This Security is issuable only in registered form without coupons in denominations of $1,000 or any amount in excess thereof which is an
integral multiple of $1,000. 
 Registration of Transfer 
 Upon due presentment for registration of transfer of this Security at the office or agency of the Company in the City of Minneapolis, Minnesota, a new Security or Securities of this series, with the same
terms as this Security, in authorized denominations for an equal aggregate Face Amount will be issued to the transferee in exchange herefor, as provided in the Indenture and subject to the limitations provided therein and to the limitations
described below, without charge except for any tax or other governmental charge imposed in connection therewith. 
 This
Security is exchangeable for definitive Securities in registered form only if (x) the Depositary notifies the Company that it is unwilling or unable to continue as Depositary for this Security or if at any time the Depositary ceases to be a
clearing agency registered under the Securities Exchange Act of 1934, as amended, and a successor depositary is not appointed within 90 days after the Company receives such notice or becomes aware of such ineligibility, (y) the Company in
its sole discretion determines that this Security shall be exchangeable for definitive Securities in registered form and notifies the Trustee thereof or (z) an Event of Default with respect to the Securities represented hereby has occurred and
is continuing. If this Security is exchangeable pursuant to the preceding sentence, it shall be exchangeable for definitive Securities in registered form, having the same date of issuance, Stated Maturity Date and other terms and of authorized
denominations aggregating a like amount. 

  
 13 

 This Security may not be transferred except as a whole by the Depositary to a nominee of the
Depositary or by a nominee of the Depositary to the Depositary or another nominee of the Depositary or by the Depositary or any such nominee to a successor of the Depositary or a nominee of such successor. Except as provided above, owners of
beneficial interests in this Global Security will not be entitled to receive physical delivery of Securities in definitive form and will not be considered the Holders hereof for any purpose under the Indenture. 

Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company or the
Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the
contrary. 
 Obligation of the Company Absolute 
 No reference herein to the Indenture and no provision of this Security or the Indenture shall alter or impair the obligation of the Company, which is absolute and unconditional, to pay the Redemption
Amount at the times, place and rate, and in the coin or currency, herein prescribed, except as otherwise provided in this Security. 
 No
Personal Recourse 
 No recourse shall be had for the payment of the Redemption Amount, or for any claim based hereon, or
otherwise in respect hereof, or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer or director, as such, past, present or future, of the Company or any successor corporation,
whether by virtue of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability being, by the acceptance hereof and as part of the consideration for the issuance hereof, expressly
waived and released. 
 Defined Terms 
 All terms used in this Security which are defined in the Indenture shall have the meanings assigned to them in the Indenture unless otherwise defined in this Security. 

Governing Law 

This Security shall be governed by and construed in accordance with the law of the State of New York, without regard to principles of
conflicts of laws. 

  
 14 

 ABBREVIATIONS 

The following abbreviations, when used in the inscription on the face of this instrument, shall be construed as though they were written
out in full according to applicable laws or regulations: 
  

					
	TEN COM	 	—	  	as tenants in common
			
	TEN ENT	 	—	  	as tenants by the entireties
			
	JT TEN	 	—	  	 as joint tenants with right
 of
survivorship and not
 as tenants in common

  

							
	UNIF GIFT MIN ACT —	 	  
	 	Custodian	 	  

		 	(Cust)	 		 	(Minor)

  

	
	Under Uniform Gifts to Minors Act
	
	  

	(State)

 Additional abbreviations may also be used though not in the above list. 

FOR VALUE RECEIVED, the undersigned hereby sell(s) and transfer(s) unto 
 Please Insert Social Security or 
 Other Identifying Number of Assignee 

 

	
	  

  
  

 
  
  

 
 (PLEASE
PRINT OR TYPE NAME AND ADDRESS INCLUDING POSTAL ZIP CODE OF ASSIGNEE)

  
 15 

 the within Security of WELLS FARGO & COMPANY and does hereby irrevocably constitute and appoint
                             attorney to transfer the said Security on the books of the Company, with full
power of substitution in the premises. 
  

	
	Dated:

  

	
	  

	
	  

 NOTICE: The signature to this assignment must correspond with the name as written upon the face of the within
instrument in every particular, without alteration or enlargement or any change whatever. 

  
 16Transition Agreement

 Exhibit 10.1 
 TRANSITION AGREEMENT 
 This Transition Agreement (the
“Agreement”) is made and entered into by and between (i) Dennis W. Blazer (“Employee”) and (ii) and CECO Environmental Corp. (“CECO”). 
 Whereas, Employee has been employed by CECO as CFO and Vice President of Finance and Administration; 
 Whereas, Employee and CECO mutually desire to transition Employee to a non CFO/consultant role and resolve amicably all differences or disputes, if any, that exist or may exist between them; 

Now, therefore, in consideration of the above and of the payments, mutual promises, and other good and valuable consideration set forth
in this Agreement, the sufficiency of which is hereby explicitly acknowledged, Employee and CECO agree as follows: 
 1. Unless
terminated sooner in accordance with terms of this Agreement, Employee’s employment with CECO shall end effective January 31, 2012 or such later date that is mutually agreeable to CECO and Employee (the date Employee’s employment
ends, the “Separation Date”). As of the earlier of the Separation Date or the effective date on which CECO hires a new Chief Financial Officer, Employee shall resign from his position as Chief Financial Officer and Vice President Finance
and Administration as well as his positions as officer of the subsidiaries of CECO. Notwithstanding the foregoing, (i) Employee may terminate his employment with CECO for any or no reason upon (A) thirty (30) days prior written notice
to CECO if a new Chief Financial Officer has not commenced employment with CECO and (B) two weeks prior written notice to CECO if a new Chief Financial Officer has commenced employment with CECO, and (ii) CECO may terminate Employee’s
employment immediately for Cause. 
 2. If Employee signs and does not revoke this Agreement, and subject to the rights and
obligations of CECO and Employee set forth herein, CECO shall provide to Employee the following payments and benefits: 
  

	 	a.	 Subject to Section 17, a transition payment equal to a total of seven (7) months of pay in the gross amount of One Hundred Fifty-One Thousand
Six Hundred and Sixty-Six Dollars and no cents ($151,666.00), which shall accrue and be paid (subject to the terms of this Agreement) as bi–weekly payments less all applicable, legally required payroll deductions, if any, starting on the first
regularly-scheduled payroll date following the Separation Date (the “Transition Payment”); provided that Employee has not been terminated by CECO for Cause. The parties understand that

	 	
payment of this Transition Payment to Employee: (i) is conditioned upon Employee’s execution and non-revocation no later than 21 days after the Separation Date of a general waiver and
release and confidentiality agreement, in a form acceptable to CECO, in favor of CECO, its officers, directors, employees and CECO’s affiliates and subsidiaries (the “General Waiver and Release Agreement”); and (ii) shall serve
as the sole consideration for Employee’s execution of the General Waiver and Release Agreement. 

  

	 	b.	During the seven month period following the Separation Date, CECO may, at its sole discretion, request that Employee perform services for CECO (the “Consulting
Period”), and it will be in Employee’s discretion as to whether to perform such services. The parties agree that Employee will be paid for such services performed, if any, at the rate of $150.00 per hour, less all applicable, legally
required payroll deductions. 

  

	 	c.	As of the Separation Date, Employee will no longer be covered by CECO medical and dental plans (the “Medical Plans”). At that time, Employee will have any
continuation rights available under the Medical Plans and as otherwise provided by law, including the Consolidated Omnibus Budget Reconciliation Act (“COBRA”). The period during which Employee will be entitled to continuation coverage
under COBRA shall begin on the day after the Separation Date. If Employee elects to continue coverage under the Medical Plans, Employee shall be responsible for premiums, as permitted by law, provided, however, that subject to the terms of this
Agreement (and more specifically Section 17), CECO will reimburse Employee for premiums paid for coverage following the Separation Date through January 31, 2014 or, if Employee resigns prior to January 31, 2012, then for a period of
eighteen months following the Separation Date (the “COBRA Reimbursements”); provided, however, that CECO shall reimburse premiums only for the plus one, HDHP 3000 plan, and in no event will CECO pay for any coverage if Employee was
terminated for Cause. Such reimbursements, subject to Section 17, will be made upon presentation by Employee of supporting documentation that the premiums have been paid. In the event that Employee finds employment that provides comparable
medical coverage at a comparable cost, Employee will elect that coverage and CECO shall have no further liability for reimbursement payments hereunder. If Employee is still covered on COBRA through CECO’s health insurance plan on June 1,
2012, or such other date when the Employee becomes Medicare eligible, Employee agrees to elect Medicare coverage thereby making Medicare the Employee’s primary medical coverage plan. 

  
 2 

	 	d.	CECO’s agreement not to contest any applicable claim for unemployment compensation by Employee, provided that Employee does not make any disparaging or false
statements about CECO in support of any such claim and provided that Employee does not resign or otherwise terminate this Agreement. In so doing, Employee fully understands that by not contesting an unemployment compensation claim, CECO cannot
guarantee that Employee will in fact receive those benefits. Moreover, Employee further understands that if CECO is required by law to provide testimony or information concerning the ending of Employee’s employment, or the payments received by
Employee pursuant to this Agreement, CECO has not breached the Agreement. 

  

	 	e.	If Employee requests input from CECO in connection with any search for subsequent employment, he shall direct any and all prospective employers to contact CECO’s
Vice President of Human Resources, currently Hilliary Jeffries, at (513) 458-2696 regarding his employment with CECO. In response to any such inquiries from prospective employers, the Vice President of Human Resources will disclose only
Employee’s dates of employment, job title and salary. 

  

	 	f.	In the event of the death of Employee prior to receipt in full of the payments and benefits in this agreement, any remaining payments and benefits will inure to the
benefit of Employee’s surviving spouse. 

  

	 	g.	“Cause” shall mean: 

 (i) negligence, fraud, dishonesty or misconduct by Employee in the performance of his duties; 
 (ii) intoxication with alcohol or drugs while on the premises of the Company or any of its subsidiaries or any customer or potential customer to the extent that in the reasonable judgment of management,
Employee is abusive or his ability to perform his duties and responsibilities is impaired; 
 (iii) conviction
of a felony or any misdemeanor involving dishonesty, theft, the failure to tell the truth, other unethical behavior, racial prejudice, drugs, alcohol, sexual misconduct or any other crime likely to result in public disparagement with respect to the
Company or its subsidiaries; 
 (iv) intentional misappropriation of property belonging to the Company or any of
its subsidiaries; 

  
 3 

 (v) illegal business practices in connection with the Company or any of its
subsidiaries’ businesses which could have a material adverse effect on the Company or any of its subsidiaries’ business or financial position or reputation; 

(vi) excessive absence of Employee from his employment during usual business hours for reasons other than vacation,
disability or sickness after written notice thereof is delivered to Employee describing the nature of such excess absences and affording Employee one more opportunity to avoid excess absences; 

(vii) failure of Employee to obey directions of the Board of Directors of CECO or the chief executive officer of the
Company, provided that Employee has been given written notice of such directions; or 
 (viii) the breach by
Employee of any confidentiality agreement between Employee and the Company. 
  

	 	h.	Employee shall be entitled to his bonus, if any, under the 2011 Executive and Mid-Management Compensation Plan, provided that he is employed with CECO as of
December 31, 2011, payable as provided under such plan. 

 Employee acknowledges that the above-referenced
payments and benefits are things of value which Employee would not receive except for his signature of this Agreement and fulfillment of the promises contained herein and that the amounts previously paid to him and those discussed in this Agreement
are all amounts owed to him in full for his services to CECO Environmental Corp. and its affiliated companies. Subject to the exceptions set forth below, Employee further agrees that the payments and other benefits constitute full, final, and
complete satisfaction of any and all “Claims” by Employee against any or all of the “Releasees,” as those terms are defined in the following paragraph. Employee further acknowledges that CECO is entering into this Agreement based
on Employee’s representation that this Agreement will resolve any and all claims that he has or could have against CECO for any issues relating to his employment or the termination of his employment and that he is waiving any right to pursue
any lawsuit against CECO with respect to his employment, the termination of his employment or any other issue that arose prior to his execution of this Agreement. 
 3. In exchange for the consideration set forth above, Employee, on behalf of himself and any heirs, dependents, spouses, beneficiaries, successors, agents, assigns, executors, and/or administrators,
hereby fully, finally, and forever releases and agrees not to sue or be a party to any lawsuit of any kind or nature against CECO, CECO’s former and current officers, directors, owners, partners, members, shareholders, representatives, agents,
employees, subsidiaries, parents, affiliates, divisions, and all other related entities of CECO and their respective heirs, predecessors, successors, and assigns, and all other persons and entities acting by, through, under, or in concert with any
of them (hereinafter, 

  
 4 

 
“Releasees”) for any and all claims, complaints, causes of action, lawsuits, rights, liabilities, obligations, promises, agreements, grievances, controversies, damages, demands, losses,
debts, costs, expenses, or attorneys’ fees (hereinafter, “Claims”), whether asserted or unasserted, known or unknown, from the beginning of time through the date Employee signs this Agreement, including but not limited to Claims
arising out of or relating to Employee’s employment with CECO and/or his separation therefrom arising under any practice, policy, contract or employment agreement or any federal, state, or local law, including without limitation Title VII of
the Civil Rights Act of 1964, the Americans with Disabilities Act (“ADA”), as amended, the Family and Medical Leave Act (“FMLA”), as amended, the Age Discrimination in Employment Act (“ADEA”), and any other federal,
state, county or local statute, ordinance, regulation or order and all claims under the common law in tort, contract or otherwise. This release specifically includes any employment-related claims for compensatory, consequential, exemplary or
punitive damages, reinstatement, equitable relief, attorneys’ fees or costs, backpay, front pay, loss of salary, net accumulations, wages, bonuses, incentive payments, commissions, expense reimbursements, rates of pay, vacations, sick days,
earnings, interest or loss of any other incidents, terms or conditions of employment. Claims released pursuant to this paragraph do not include (i) applicable and vested benefits to which Employee is entitled, if any, pursuant to CECO’s
retirement plan(s), as set forth in and governed by the formal Plan Document(s), (ii) any right of Employee to indemnification for service in his capacity as an officer, director, employee or agent of CECO pursuant to agreement, CECO’s
organizational documents, by statute or under any CECO insurance policy, or (iii) any rights of Employee under this Agreement. Employee acknowledges and agrees he is entitled to no further payments or other benefits in light of the payments
being made under Paragraph 2 above. Employee warrants that he has not assigned or transferred any Claims against Releasees to any other person or entity. Except as expressly provided for herein, this release of Claims also shall include
Employee’s entitlement to any benefits under all other employee benefit programs sponsored or maintained by or on behalf of CECO. 
 Employee understands and agrees that by this release he is giving up the opportunity to recover any form of compensation, damages or any other form of relief in any proceeding brought by him or on his
behalf. Employee’s release and this Agreement shall not operate to waive or bar any claim or right which may not by operation of law or regulation be waived or barred. Employee expressly acknowledges that he has not filed any Claim regarding
any matter described in this Agreement and, if he does file such a Claim, he will be in breach of the Agreement and CECO shall be entitled to revoke or recover from him all consideration given under this Agreement as well as its attorneys’ fees
and costs incurred in defending against such action. 
 4. Exclusively as this Agreement pertains to Employee’s release of
Claims, if any, under the Age Discrimination in Employment Act (“ADEA”), 29 U.S.C. § 621 et seq., Employee, pursuant to and in compliance with the Older Workers Benefit Protection Act: (i) is advised to consult with an
attorney prior to executing this Agreement; (ii) is afforded a period of twenty-one (21) calendar days to consider this Agreement; and (iii) may revoke this Agreement (with regard to his ADEA waiver and release) during the

  
 5 

 
seven (7) calendar days following his signature of the Agreement. Employee’s knowing and voluntary execution of this Agreement is an express acknowledgment and agreement that Employee
had the opportunity to review this Agreement with an attorney if he so desired; that Employee was afforded twenty-one (21) days to consider the Agreement before executing it (even if he voluntarily chose to sign the Agreement prior to the
expiration of the 21-day period); that Employee agrees this Agreement is written in a manner that enables him fully to understand its content and meaning; and that Employee is being given seven (7) days to revoke the Agreement. 

This Agreement as it pertains to the release of Claims under the ADEA shall become effective and enforceable seven (7) calendar days
after Employee signs it, as long as it is not revoked prior to that time. All other provisions of the Agreement or parts thereof shall become effective and enforceable upon execution; provided, however, that if Employee revokes the Agreement as
provided in (iii) above, CECO may revoke the Agreement in its entirety during the seven (7) calendar day period following Employee’s revocation. Notice of revocation by Employee must be in writing and delivered to CECO’s Vice
President of Human Resources, Hilliary Jeffries, at 4625 Red Bank Road Suite 200, Cincinnati Ohio 45227, on or before the effective date of revocation. Notice of revocation by CECO must be in writing, and delivered to Employee, at 7621 Hillridge
Ct., Cincinnati, Ohio 45244. 
 5. In exchange for mutual covenants set forth in this Agreement, and as a material inducement
for Employee to enter into this Agreement, CECO further agrees to refrain from making or publishing any disparaging or false statements, oral or written, about Employee. For purposes of this paragraph 5, CECO means the Vice President of Human
Resources, all current members of the CECO Board of directors, the Chief Executive Officer and the Chief Financial Officer. 

6. In exchange for Employee’s receipt of the above-referenced payments and benefits, and as a material inducement for CECO to enter
into this Agreement, Employee further agrees: 
  

	 	a.	During the Consulting Period, and as long as reasonably necessary thereafter, Employee agrees that he will cooperate, assist, and make himself reasonably available to
CECO personnel or CECO attorneys and/or agents on an as-needed basis (i) in order to respond to or address any complaint or issue raised by any person or entity that does/did business with CECO or is/was associated with CECO and
(ii) in connection with any formal or informal governmental or self-regulatory organization investigation. Employee agrees that he will provide truthful and accurate sworn testimony in the form of deposition, affidavit, and/or otherwise if
requested by CECO. CECO will strive to keep the need for future assistance to a minimum, and will reimburse Employee for reasonable expenses incurred, unless such remuneration would be inappropriate or otherwise prohibited under existing law.

  
 6 

	 	b.	To refrain from making or publishing any disparaging or false statements, oral or written, about CECO or any of the other Releasees. 

 

	 	c.	To return all CECO-owned property (“Property”) (except for the Dell Latitude E6520 laptop and Blackberry Curve cell phone currently in his possession) that
has not been returned already to CECO on Employee’s Separation Date, except to the extent necessary, and only for so long as necessary, to perform services requested by and for CECO. Upon completion of such services, or earlier if requested by
CECO, all such Property shall be returned to CECO. Any such Property should be returned to Jeff Lang or his designee. The term “Property” includes, without limitation, correspondence, files, e-mails, memos, reports, minutes, plans,
records, surveys, identification cards, security access cards or devices, keys, confidential or proprietary software, diagrams, computer printouts, computer disks or CDs, hard drives, manuals, customer or vendor documentation, or any other medium,
electronic, digital, or otherwise, for storing information, and all copies or reproductions of any such Property. The return of all Property includes the complete and effective deletion of all CECO material on Employee’s personal computer, if
Employee has one. 

  

	 	d.	That, except as permitted by Paragraph 6.c, neither Employee nor anyone else at Employee’s direction has copied in any manner or otherwise retained any such
Property. Employee further agrees that all information disclosed to or discovered by Employee during his employment with CECO regarding CECO’s operations, services, products, procedures, practices, processes, or systems, including but not
limited to sales and marketing strategies; prior, current, or potential client lists or client information; pricing or bidding information and practices; vendor/supplier information; compensation policies; research and development information;
environmental matters; computer or telephone systems, directories, and/or database information; personnel matters; trade secrets; planning goals; management action plans; and/or financial information, are collectively considered “Confidential
Information” and are valuable and unique assets of CECO, unless such information generally is known or could be readily ascertainable by the general public through no fault of Employee. Therefore, Employee shall not, directly or indirectly,
intentionally or unintentionally, use, disseminate, or disclose any Confidential Information to any other person or entity. Employee agrees that CECO’s remedy at law for any breach of this Paragraph 6.d. would be inadequate and, therefore,
agrees and consents that temporary and permanent injunctive relief may be granted in any proceeding to enforce this Paragraph 6.d. 

  
 7 

 7. Employee represents and warrants that he has not (a) assigned or transferred any
Claims against any of the Releasees to any other person or entity, (b) filed any Claims against any of the Releasees with any local, state, or federal agency, department, or court, or (c) claimed an interest in any such Claims. CECO
represents and warrants that it has not (i) assigned or transferred any Claims against Employee to any other person or entity, or (ii) filed any Claims against Employee, or (iii) claimed an interest in any such Claims. Employee also
waives the right to recover any monetary damages or other relief brought by or through the Equal Employment Opportunity Commission (“EEOC”) or any other local, state, or federal agency, department, or court. 

8. The terms and intention of this Agreement are to end amicably the employment relationship between Employee and CECO and compromise and
settle any existing or potential Claims. Employee and CECO acknowledge and agree that neither this Agreement nor any actions or statements taken or made hereunder constitute evidence of any liability under, violation of, or noncompliance with any
law or statute, regulation, the common law, or any agreement which exists or allegedly may exist by and between Employee and CECO, nor the admission of any wrongdoing or liability of CECO or any of the other Releasees or Employee. Each of CECO and
Employee specifically denies and disclaims any liability and by entering into this Agreement intends merely to resolve any differences in an amicable way. 
 9. Employee agrees that the discussions concerning this Agreement are confidential. Accordingly, Employee shall not disclose any discussions about this Agreement to any person or entity other than his
attorney, tax advisor, accountant, or spouse, or as otherwise required and compelled by law. In so doing, Employee shall instruct his attorney, tax advisor, accountant, and/or spouse that the discussions are confidential and shall not be disclosed
to any other person or entity. If compelled by law to disclose the above-referenced information, Employee shall immediately notify CECO’s Vice President of Human Resources.  

10. Each of CECO and Employee further understands and agrees that the pledges of confidentiality, non-disparagement, and non-disclosure
set forth above are material inducements to the other party to enter into the Agreement, and that any breach of such provisions by a party would entitle the other party to recover such party’s actual damages and reasonable attorney’s fees.

 11. This Agreement is binding upon and inures to the benefit of Employee and CECO and their respective heirs, administrators,
representatives, executors, successors, and assigns. 
 12. This Agreement sets forth the entire understanding and agreement
between Employee and CECO and supersedes any and all prior agreements (except as provided herein) or understandings with respect to the subject matter of this Agreement, 

  
 8 

 
whether oral or written; provided, however, that if prior to the Separation Date there is a Change in Control, as defined in that certain Change in Control Agreement dated October 16, 2009
between Employee and CECO (the “CiC Agreement”), the CiC Agreement shall control with respect to the amount, timing and requirements for post-employment payments, including without limitation payments for Medical Plans. This Agreement
cannot be modified or terminated orally, but may be changed only in a written document signed by both Employee and the Chief Executive Officer of CECO which specifically states that such writing amends this Agreement. 

13. Employee acknowledges that in executing this Agreement, he does not rely and has not relied upon any representation or statement made
by any or all of the Releasees with regard to the subject matter, basis, tax consequences, or effect of this Agreement or otherwise, other than the obligations of the parties set forth in writing in this Agreement. Employee also assumes the risk of
all possible differences in facts if any facts Employee now believes to be true are found to be different than he believes. 

14. If, for any reason, any portion of this Agreement should be found invalid or unenforceable, all remaining parts shall remain binding
and in full force and effect to the maximum extent permitted under Ohio law. 
 15. This Agreement shall be interpreted,
enforced, and governed by the laws of the State of Ohio, without regard to any choice of law or conflict of law provisions. Employee acknowledges and consents to exclusive jurisdiction and venue, with regard to this Agreement, in the state and
federal courts located in Hamilton County, Ohio. 
 16. EMPLOYEE AGREES THAT HE IS FULLY ABLE AND COMPETENT TO ENTER INTO THIS
AGREEMENT, HAS READ THE AGREEMENT CAREFULLY AND IN ITS ENTIRETY, HAS TAKEN REASONABLE TIME TO CONSIDER IT, HAS HAD THE OPPORTUNITY, SHOULD EMPLOYEE SO DESIRE, TO HAVE COUNSEL OF CHOICE REVIEW IT, FULLY UNDERSTANDS ITS TERMS, AND THAT HIS AGREEMENT
TO ALL OF ITS PROVISIONS IS MADE FREELY, VOLUNTARILY, AND WITH FULL KNOWLEDGE AND UNDERSTANDING OF ITS TERMS AND CONTENTS. 

17. Notwithstanding any provision to the contrary in this Agreement: 

 

	 	a.	No Transition Payment or COBRA Reimbursement shall be payable unless the termination of the Employee’s employment constitutes a “separation from service”
within the meaning of Section 1.409A-1(h) of the Department of Treasury Regulations. 

  

	 	b.	 If the Employee is deemed at the time of his separation from service to be a “specified employee” for purposes of
Section 409A(a)(2)(B)(i) of the Internal Revenue Code of 1986, as amended (the “Code”), to the extent delayed commencement of any portion of the benefits to which the Employee is entitled under

  
 9 

	 	
this Agreement (after taking into account all exclusions applicable to such termination benefits under Section 409A) is required in order to avoid a prohibited distribution under
Section 409A(a)(2)(B)(i) of the Code, such portion of the Employee’s benefits shall not be provided to the Employee prior to the earlier of (A) the expiration of the six-month period measured from the date of the Employee’s
“separation from service” with CECO (including any employers required to be aggregated with CECO in accordance with Department of Treasury Regulations issued under Section 409A of the Code) or (B) the date of the Employee’s
death. Within three (3) business days of the earlier of such dates, all payments deferred pursuant to this Section 17.b. shall be paid in a lump sum to the Employee, and any remaining payments due under the Agreement shall be paid as
otherwise provided herein. 

  

	 	c.	The determination of whether the Employee is a “specified employee” for purposes of Section 409A(a)(2)(B)(i) of the Code as of the time of his separation
from service shall be made by CECO in accordance with the terms of Section 409A of the Code and applicable guidance thereunder (including without limitation Section 1.409A-1(i) of the Department of Treasury Regulations and any successor
provision thereto). 

  

	 	d.	COBRA Reimbursements shall be made no later than December 31 of the year following the year in which the expense was incurred. The amount of expenses reimbursed in
one year shall not affect the amount eligible for reimbursement in any subsequent year. 

  
 10 

 IN WITNESS WHEREOF, the parties have executed this Agreement as of the date set forth above, but actually on
the dates set forth below. 
  

									
	Dennis W. Blazer	 		 	CECO ENVIRONMENTAL CORP.:
				
	 /s/ Dennis W. Blazer
	 		 	By:	 	   /s/ Jeffrey Lang

	EMPLOYEE	 		 		 	  Jeffrey Lang
		 		 		 		 	  Chief Executive Officer
					
	Date:	 	 8-19-11
	 		 	Date:	 	 8-19-11

									
					
	Witness:	 	 /s/ Hilliary L. Jeffries
	 		 		 	

  
 11 

 CECO Environmental Corp. 

4625 Red Bank Road Suite 200 
 Cincinnati, Ohio 45227 
 ACKNOWLEDGMENT OF RECEIPT 

I, Dennis W. Blazer (“Employee”), acknowledge receipt of the attached Transition Agreement (the “Agreement”) between
myself and CECO Environmental Corp. (“CECO”). 
 I received a copy of the Agreement on the     
day of            , 2011. I understand that for the Agreement to be effective, I must sign and return it to CECO’s Vice President of Human Resources, Hilliary Jeffries, by 5:00 p.m.,
within twenty-one (21) calendar days from the above date. 
 During the time given to review the Agreement, I understand
and agree that if I violate any of the provisions of the Agreement before I sign it, CECO may, in its sole discretion, withdraw the Agreement in its entirety. 
 Signature on this Acknowledgment of Receipt only indicates receipt of the Agreement. 
  

									
	  
	 		 	  

	Employee	 		 	Witness
					
	Date:	 	  
	 		 	Date:	 	  

  
 12

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