Document:

exv4w8

 

Exhibit 4.8

AMENDED AND RESTATED STOCK TRADING AGREEMENT

     This Amended and Restated Stock Trading Agreement, dated as of March 19,
2004 (as it may be amended, restated or modified and in effect from time to
time, this “Agreement”), is made by and among Electric City Corp., a
Delaware corporation (the “Company”), Newcourt Capital USA, Inc., a
Delaware corporation (“Newcourt Capital”), Originators Investment Plan,
L.P., a Delaware limited partnership (“OIP), Morgan Stanley Dean Witter Equity
Funding, Inc., a Delaware corporation (“Morgan Stanley”), Cinergy
Ventures II, LLC, a Delaware limited liability company (“Cinergy
Ventures”), Leaf Mountain Company LLC, an Illinois limited liability
company (“Leaf Mountain”), SF Capital Partners Ltd., a British Virgin
Islands company (“SF Capital”), Richard P. Kiphart, an individual
(“Kiphart” ), David R. Asplund, an individual (“Asplund”), John
Thomas Hurvis Revocable Trust, an Illinois trust (“Hurvis Trust”), John
Donohue, an individual (“Donohue”), Augustine Fund, LP, an Illinois
limited partnership (“Augustine”), and Technology Transformation Venture
Fund, LP, a Delaware limited partnership (“TVP”) (collectively, Newcourt
Capital, OIP, Morgan Stanley, Cinergy Ventures, Leaf Mountain, SF Capital,
Kiphart, Asplund, Hurvis Trust, Donohue, Augustine and TVP are referred to
herein as the “Investors”), CIT Capital Securities, Inc. (formerly known
as Newcourt Capital Securities, Inc.), a Delaware corporation (“CIT Capital
Securities”) , and each of the members of management of the Company set
forth on the signature pages hereto, and shall become effective on September 8,
2004, as more fully set forth below.

W I T N E S S E T H:

     WHEREAS, each of the Investors is a holder of certain shares of the
Company’s outstanding Series A Convertible Preferred Stock (“Series A
Preferred”), Series C Convertible Preferred Stock (“Series C
Preferred”) and/or Series D Convertible Preferred Stock (“Series D
Preferred” and, together with the Series A Preferred and the Series C
Preferred, the “Existing Preferred Stock”), and each Investor is also a
holder of shares of Common Stock (as hereinafter defined), and each Investor is
also a holder of certain warrants to purchase additional shares of Common Stock
of the Company and certain Investors are also holders of warrants to purchase
additional shares of Series D Preferred; and

     WHEREAS, CIT Capital Securities also holds a warrant to purchase shares of
Common Stock of the Company; and

     WHEREAS, the parties hereto have previously entered into one or more of
the following: that certain Stock Trading Agreement, dated as of July 31, 2001,
as amended, that certain Stock Trading Agreement, dated as of June 4, 2002 or
that certain Stock Trading Agreement dated as of June 27, 2003 (collectively,
the “Prior Agreements”); and

     WHEREAS, the Company and the Investors have entered into that certain
Redemption and Exchange Agreement, dated as of March 19, 2004 (as it may be
amended, restated or modified and in effect from time to time, the
“Redemption and Exchange Agreement”),
whereby the Company will redeem certain shares of Existing Preferred Stock
held by some Investors and all of the Investors will exchange their remaining
shares of the Company’s Existing Preferred

 

 

Stock for shares of the Company’s
Series E Convertible Preferred Stock, par value $0.01 per share (the “Series
E Preferred Stock”) and the Investors holding warrants to purchase shares
of the Series D Preferred will exchange such warrants for replacement warrants
to purchase shares of Series E Preferred Stock, all as more fully described in
the Redemption and Exchange Agreement; and

     WHEREAS, it is a condition to the obligations of the Investors and the
Company to closing of the transactions contemplated by the Redemption and
Exchange Agreement that the Company and the Parties enter into this Agreement;
and

     WHEREAS, the Company and the Parties hereto desire that this Agreement
supersede and replace all three of the Prior Agreements in their entirety;

     NOW, THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt and adequacy of which are hereby
acknowledged, the parties hereto agree as follows:

ARTICLE I

DEFINITIONS

     1.1     Defined Terms. All terms capitalized but not defined herein
shall have the meaning attributable to such terms in the Redemption and
Exchange Agreement, except where the context otherwise requires. The following
additional terms when used in this Agreement, including its preamble and
recitals, shall, except where the context otherwise requires, have the
following meanings, such meanings to be equally applicable to the singular and
plural forms thereof:

     “Affiliate” means, as applied to any Person, any other Person
controlling, controlled by or under common control with such Person. For
purposes of this definition, “control” (including, with correlative meanings,
the terms “controlled by” and “under common control with”), as applied to any
Person, shall mean the possession, directly or indirectly, of the power to
direct or cause the direction of the management and policies of any such other
Person, whether through the ownership of voting securities or by contract or
otherwise. With respect to individuals, the term Affiliate shall also include
such individual’s parents, spouse, children or grandchildren.

     “Agreement” shall have the meaning set forth in the preamble
hereof.

     “Average Daily Trading Volume” with respect to any trading day,
means the average daily trading volume of the Common Stock as reported on the
American Stock Exchange (or, if not traded on the American Stock Exchange, any
national securities exchange or automated quotation services on which the
Common Stock is then listed for trading) for the twenty (20) consecutive
trading days (as adjusted to exclude the highest and the lowest volume trading
days for such twenty (20) consecutive trading day period) ending on the date
immediately prior to such trading day.

     “Block Sales” means a sale of at least 10,000 shares of Common
Stock.

2

 

     “Closing Price” means the closing price of the Common Stock as
reported on the American Stock Exchange (or, if not traded on the American
Stock Exchange, any national securities exchange or automated quotation
services on which the Common Stock is then listed for trading).

     “Common Stock” means and includes the Company’s authorized common
stock, par value $0.0001 per share.

     “Company” shall have the meaning set forth in the preamble hereof.

     “Investors” shall have the meaning set forth in the preamble
hereof.

     “Parties” means all of the parties that are signatories to this
Agreement from time to time, including under any joinders executed pursuant to
the terms hereof, other than the Company.

     “Person” means and includes an individual, a corporation, a limited
liability company, an association, a partnership, a trust or estate, a
government or any department or agency thereof.

     “Redemption and Exchange Agreement” shall have the meaning set
forth in the fourth WHEREAS clause hereof.

ARTICLE II

TRADING RESTRICTIONS

     2.1     Agreement for Benefit of Company. Each Party hereby agrees
that its obligations under this Agreement are for the benefit of the Company
and further agrees that the Company shall be entitled to enforce such Party’s
obligations under this Agreement.

     2.2     Effective Date; Public Sales. This Agreement shall become
effective on September 8, 2004. Until such date, the Prior Agreements shall
continue in full force and effect. On September 8, 2004, the Prior Agreements
shall each terminate and be of no further force or effect. On and after
September 8, 2004, during the term of this Agreement, no Party may sell any of
its Common Stock into the public market except in accordance with the following
trading restrictions:

     (a)     During the term of this Agreement and at any time the Closing
Price on the then prior trading day is $4.00 per share or more, no
restrictions hereunder shall apply.

     (b)     During the term of this Agreement and at any time the Closing
Price on the then prior trading day is at least $2.00 per share but less
than $4.00 per share, such Party may sell any of its Common Stock into
the public market, subject to the following conditions:

	 	(i)	 	the number of shares of Common Stock sold by such
Party on any trading day may not exceed fifteen percent (15%)
of the Average Daily Trading Volume; and

3

 

	 	(ii)	 	Block Sales by such Party must be executed at a
minimum price per share of 90% of the ask price as reported on
the American Stock Exchange (or, if not traded on the American
Stock Exchange, any national securities exchange or automated
quotation services on which the Common Stock is then listed
for trading).

     (c)     During the term of this Agreement and at any time the Closing
Price on the then prior trading day is at least $1.00 per share but less
than $2.00 per share, such Party may sell any of its Common Stock into
the public market, subject to the following conditions:

	 	(i)	 	the number of shares of Common Stock sold by such
Party on any trading day may not exceed ten percent (10%) of
the Average Daily Trading Volume; and
	 
	 	(ii)	 	Block Sales by such Party must be executed at a
minimum price per share of 90% of the ask price as reported on
the American Stock Exchange (or, if not traded on the American
Stock Exchange, any national securities exchange or automated
quotation services on which the Common Stock is then listed
for trading).

     (d)     During the term of this Agreement and at any time the Closing
Price on the then prior trading day is less than $1.00 per share, such
Party may sell any of its Common Stock into the public market, subject to
the following conditions:

	 	(i)	 	the number of shares of Common Stock sold by such
Party on any trading day may not exceed five percent (5%) of
the Average Daily Trading Volume; and
	 
	 	(ii)	 	Block Sales by such Party must be executed at a
minimum price per share of 90% of the ask price as reported on
the American Stock Exchange (or, if not traded on the American
Stock Exchange, any national securities exchange or automated
quotation services on which the Common Stock is then listed
for trading).

     2.3.     Private Sales. Any Party may sell any of its shares of Series
E Preferred Stock or Common Stock (or securities exercisable or exchangeable
for or convertible into shares of Series E Preferred Stock or Common Stock) it
owns in a private transaction not effected over any securities exchange;
provided, however, that any such private sale of shares of Series
E Preferred Stock or Common Stock (or securities exercisable or exchangeable
for or convertible into shares of Series E Preferred Stock or Common Stock) to
a party that is not a Party to this Agreement shall have as a condition to such
sale that such acquiring party shall become a Party to this Agreement by
executing a joinder hereto with the Company acknowledging that the shares of
Series E Preferred Stock or Common Stock (or securities
exercisable or exchangeable for or convertible into shares of Series E
Preferred Stock or Common Stock) being acquired shall be subject to the terms
hereof while this Agreement remains in effect.

4

 

     2.4     Transfer to Affiliates. Notwithstanding anything in this
Agreement to the contrary, any party may freely sell or otherwise transfer any
Series E Preferred Stock or Common Stock (or securities exercisable or
exchangeable for or convertible into shares of Series E Preferred Stock or
Common Stock) it owns to its Affiliates without such sale or transfer being
subject to the terms of this Agreement; provided, however, that
any such Affiliate shall become a party to and bound by this Agreement and its
ownership and sales of shares of Series E Preferred Stock or Common Stock or
other securities exercisable or exchangeable for or convertible into shares of
Series E Preferred Stock or Common Stock shall be aggregated with the
transferring Party for purposes of Sections 2.1 and 2.2.

     2.5     Term of Trading Agreement. The term of this Agreement shall
terminate on September 7, 2007.

     2.6     Amendments to the Trading Agreement. This Agreement may only
be amended upon the prior written consent of the Company and all other Parties
at the time of such amendment.

     2.7     Purchases by Management in the Public Market. Notwithstanding
anything in this Article II to the contrary, all shares of Common Stock
purchased by members of management that are signatories hereto in the public
market from other than the Company or its underwriters shall not be subject to
this Article II.

     2.8     Agreement Not Applicable to Michael Pokora or Brian Kawamura.
The Parties and the Company acknowledge that Michael Pokora and Brian Kawamura
were each signatories to the 2001 Stock Trading Agreement and that Messrs.
Pokora and Kawamura have since ceased to be officers or employees of the
Company or any of its Subsidiaries. Accordingly, the Parties and the Company
each hereby agree that Messrs. Pokora and Kawamura shall not be Parties to this
Agreement, without prejudice to any of their rights or obligations under the
2001 Stock Trading Agreement.

     2.9     Agreement Not Applicable to Certain SF Capital Partners, Ltd Common
Stock. The Parties and the Company acknowledge that SF Capital Securities,
Ltd. and the Company were signatories to a Stock Trading Agreement dated as of
February 27, 2003 (the “SF Capital Trading Agreement”) which was entered
into in connection with the purchase by SF Capital Partners, Ltd. from the
Company of 1,086,957 shares of Common Stock (including any adjustments
occurring thereto after the date hereof for stock splits, stock combinations
and the like, the “Excluded SF Capital Common Shares”) and warrants (the
“Excluded SF Capital Common Stock Warrants”) evidenced by Warrant No. 32
issued by the Company to purchase up to 300,000 additional shares of Common
Stock (including any adjustments occurring thereto after the date hereof for
stock splits, stock combinations and the like, the “Excluded SF Capital
Warrant Shares”). The Parties and the Company hereby agree that (a) this
Agreement does not apply with respect to any Excluded SF Capital Common Shares
or any Excluded SF Capital Common Stock Warrants or any Excluded SF
Capital Warrant Shares; and (b) that the SF Capital Trading Agreement has
been terminated, effective March 20, 2004.

     2.10     Agreement Not Applicable to Certain Kiphart Common Stock. The
Parties and the Company acknowledge that Richard P. Kiphart and the Company are
signatories to a Stock

5

 

Trading Agreement dated as of April 23, 2003 (the
“Kiphart Trading Agreement”) which was entered into in connection with
the purchase by Richard P. Kiphart from the Company of 456,429 shares of Common
Stock (including any adjustments occurring thereto after the date hereof for
stock splits, stock combinations and the like, the “Excluded Kiphart Common
Shares”) and warrants (the “Excluded Kiphart Common Stock Warrants”)
evidenced by Warrant No. 41 issued by the Company to purchase up to 125,974
additional shares of Common Stock (including any adjustments occurring thereto
after the date hereof for stock splits, stock combinations and the like, the
“Excluded Kiphart Warrant Shares”). The Parties and the Company hereby
agree that (a) this Agreement does not apply with respect to any Excluded
Kiphart Common Shares or any Excluded Kiphart Common Stock Warrants or any
Excluded Kiphart Warrant Shares; and (b) that this Agreement does not amend,
modify, supersede or otherwise in any manner change or affect the Kiphart
Trading Agreement, which remains in full force and effect in accordance with
its terms.

ARTICLE III

GENERAL PROVISIONS

     3.1     Legend on Share Certificates.

     (a)     After this Agreement becomes effective, all Company securities that
are subject to the terms and provisions of Article II, in addition to
such other legends as may be required by law and any other legend required by
the Redemption and Exchange Agreement or any Ancillary Agreements (as defined
in the Redemption and Exchange Agreement) shall bear the following legend:

THE SECURITIES REPRESENTED BY THIS CERTIFICATE ARE
ALSO SUBJECT TO CERTAIN REQUIREMENTS AS TO TRADING
CONTAINED IN THE AMENDED AND RESTATED STOCK TRADING
AGREEMENT, DATED MARCH 19, 2004, BY AND AMONG THE
COMPANY AND CERTAIN SECURITY HOLDERS, A COPY OF WHICH
IS ON FILE WITH THE SECRETARY OF THE COMPANY.

     (b)     Upon the termination of this Agreement, each Party shall be entitled
to receive, in exchange for any security bearing the legend regarding this
Agreement specifically set forth in Section 3.1(a), a security without
such legend.

ARTICLE IV

MISCELLANEOUS

     4.1     Injunctive Relief. It is acknowledged that it is impossible to
measure in money the damages that would be suffered if the Parties fail to
comply with the obligations imposed on them by this Agreement and that, in the
event of any such failure, an aggrieved Party
would be irreparably damaged and would not have an adequate remedy at law.
Any such Party shall, therefore, be entitled to injunctive relief and/or
specific performance to enforce such obligations, and if any action should be
brought in equity to enforce any of such provisions of this Agreement, none of
the Parties shall raise the defense that there is an adequate remedy at law.

6

 

     4.2     Governing Law. Except as to matters governed by the General
Corporation Law of the State of Delaware and decisions thereunder of the
Delaware courts applicable to Delaware corporations, which shall be governed by
such laws and decisions, this Agreement shall be construed and enforced in
accordance with, and the rights of the parties shall be governed by, the laws
of the State of Illinois.

     4.3     Entire Agreement; Waiver. As among the Parties and the
Company, this Agreement supersedes the Prior Agreements and contains the entire
agreement among the parties hereto with respect to the subject matter hereof.
No waiver of any term or provision shall be effective unless in writing signed
by the party to be charged. This Agreement does not modify, amend or otherwise
affect either the SF Capital Trading Agreement (as defined in Section 2.8) or
the Kiphart Trading Agreement (as defined in Section 2.9).

     4.4     Binding Effect. This Agreement shall be binding on and inure
to the benefit of the Parties and, subject to the terms and provisions hereof,
their respective legal representatives, successors and assigns.

     4.5     Invalidity of Provision. The invalidity or unenforceability of
any provision of this Agreement in any jurisdiction shall not affect the
validity or enforceability of the remainder of this Agreement in that
jurisdiction or the validity or enforceability of this Agreement, including
that provision, in any other jurisdiction.

     4.6     Counterparts. This Agreement may be executed in two or more
counterparts, all of which shall be deemed but one and the same instrument and
each of which shall be deemed an original, and it shall not be necessary in
making proof of this Agreement to produce or account for more than one such
counterpart for each of the parties hereto. Delivery by facsimile by any of
the parties hereto of an executed counterpart of this Agreement shall be
effective as an original executed counterpart hereof and shall be deemed a
representation that an original executed counterpart hereof will be delivered.

     4.7     Notices. All notices, consents and other communications under
this Agreement shall be in writing and shall be deemed to have been duly given
when (a) delivered by hand, (b) sent by telecopier (with receipt confirmed),
provided that a copy is mailed by certified or registered mail, return receipt
requested, or (c) when received by the addressee, if sent by Express Mail,
Federal Express or other express delivery service (receipt requested), in each
case to the appropriate addresses and telecopier numbers set forth below (or to
such other addresses and telecopier numbers as a party may designate as to
itself by notice in accordance herewith given to each of the other parties):

7

 

	 	(i)	 	If to the Company:
	 
	 	 	 	1280 Landmeier Road

Elk Grove Village, IL 60007-2410

Fax No. 847-437-4969

Attention: Chief Financial Officer

	 
	 	(ii)	 	If to a Party: at the address set
forth in the Redemption and Exchange Agreement or the
signature page to this Agreement.

     4.8     Headings. The descriptive headings of the several paragraphs
of this Agreement are inserted for convenience only and do not constitute part
of this Agreement.

[BALANCE OF PAGE INTENTIONALLY LEFT BLANK; SIGNATURE PAGE FOLLOWS.]

8

 

     IN WITNESS WHEREOF, the parties hereto have caused this Amended and
Restated Stock Trading Agreement to be executed as of the day and year first
above written.

	 	 	 	 	 	 	 
	COMPANY	 	INVESTORS
	 
	 	 	 	 	 	 
	ELECTRIC CITY CORP.,	 	NEWCOURT CAPITAL USA INC.,
	 
	 	 	 	 	 	 
	By:

	 	/s/ John Mitola

	 	By:
	 	/s/ Daniel M. Morash

	Name:

	 	John Mitola
	 	Name:
	 	Daniel M. Morash
	Title:

	 	Chief Executive Officer
	 	Title:
	 	Managing Director
	 
	 	 	 	 	 	 
	MANAGEMENT	 	CIT CAPITAL SECURITIES, INC.
	 
	 	 	 	 	 	 
	JOHN MITOLA
 	 	By:	 	/s/ Daniel M. Morash

	 

	 	 	 	Name:
	 	Daniel M. Morash
	/s/ John Mitola

	 	Title:	 	Managing Director
	 
	 	 	 	 	 	 
	 	 	 	 	MORGAN STANLEY DEAN WITTER EQUITY FUNDING, INC.
	 
	 	 	 	 	 	 
	JEFFREY MISTARZ	 	 	 	 
	 

	 	 	 	By:
	 	/s/ James T. Keane

	 

	 	 	 	Name:
	 	James T. Keane
	/s/ Jeffrey Mistarz

	 	Title:	 	Vice President
	 
	 	 	 	 	 	 
	 	 	 	 	ORIGINATORS INVESTMENT PLAN, L.P.
	 
	 	 	 	 	 	 
	DENIS ENBERG	 	 	 	 
	 

	 	 	 	By:
	 	MSDW OIP Investors, Inc.,

its general partner
	 
	 	 	 	 	 	 
	/s/ Denis Enberg

	 	By:	 	/s/ James T. Keane

	 

	 	 	 	Name:
	 	James T. Keane
	 

	 	 	 	Title:
	 	Vice President
	 
	 	 	 	 	 	 
	 	 	 	 	CINERGY VENTURES II, LLC
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Richard G. Beach

	 

	 	 	 	Name:
	 	Richard G. Beach
	 

	 	 	 	Title:
	 	Assistant Secretary

9

 

	 	 	 	 	 	 	 
	 	 	 	 	LEAF MOUNTAIN COMPANY, LLC
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Jack J. Jiganti

	 

	 	 	 	Name:
	 	Jack J. Jiganti
	 

	 	 	 	Title:
	 	Manager
	 
	 	 	 	 	 	 
	 	 	 	 	SF CAPITAL PARTNERS, LTD.
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Brian H. Davidson

	 

	 	 	 	Name:
	 	Brian H. Davidson
	 

	 	 	 	Title:
	 	Authorized Signatory
	 
	 	 	 	 	 	 
	 	 	 	 	RICHARD KIPHART
	 
	 	 	 	 	 	 
	 	 	 	 	/s/ Richard Kiphart

	 
	 	 	 	 	 	 
	 	 	 	 	DAVID R. ASPLUND
	 
	 	 	 	 	 	 
	 	 	 	 	/s/ David R. Asplund

	 
	 	 	 	 	 	 
	 	 	 	 	JOHN THOMAS HURVIS REVOCABLE TRUST
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ John Thomas Hurvis

	 

	 	 	 	Name:
	 	John Thomas Hurvis
	 

	 	 	 	Title:
	 	Trustee
	 
	 	 	 	 	 	 
	 	 	 	 	JOHN DONOHUE
	 
	 	 	 	 	 	 
	 	 	 	 	/s/ John Donohue

	 
	 	 	 	 	 	 
	 	 	 	 	AUGUSTINE FUND LP

10

 

	 	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Thomas Duszynski

	 

	 	 	 	Name:
	 	Thomas Duszynski
	 

	 	 	 	Title:
	 	Chief Financial Officer
	 
	 	 	 	 	 	 
	 	 	 	 	TECHNOLOGY TRANSFORMATION VENTURE FUND, LP
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ William M. Custer

	 

	 	 	 	Name:
	 	William M. Custer
	 

	 	 	 	Title:
	 	President

11exv4w9

 

Exhibit 4.9

FORM OF SERIES E CONVERTIBLE PREFERRED STOCK WARRANT

THE SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED,
QUALIFIED, APPROVED OR DISAPPROVED UNDER THE SECURITIES ACT OF 1933, AS
AMENDED, OR THE SECURITIES LAWS OF ANY STATE AND MAY NOT BE SOLD OR OTHERWISE
DISPOSED OF EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER SUCH
ACT AND APPLICABLE STATE SECURITIES LAWS OR AN APPLICABLE EXEMPTION FROM THE
REGISTRATION REQUIREMENTS OF SUCH ACT OR SUCH LAWS AND NEITHER THE UNITED
STATES SECURITIES AND EXCHANGE COMMISSION NOR ANY OTHER FEDERAL OR STATE
REGULATORY AUTHORITY HAS PASSED ON OR ENDORSED THE MERITS OF THESE SECURITIES.

THE SERIES E PREFERRED STOCK ISSUABLE UPON THE EXERCISE OF THE SECURITIES
REPRESENTED HEREBY AND THE COMMON STOCK ISSUABLE UPON CONVERSION OF SUCH SERIES
E PREFERRED STOCK ARE SUBJECT TO AN AMENDED AND RESTATED STOCKHOLDERS
AGREEMENT, AN AMENDED AND RESTATED INVESTOR RIGHTS AGREEMENT AND AN AMENDED AND
RESTATED STOCK TRADING AGREEMENT, AS EACH OF THE SAME MAY BE AMENDED FROM TIME
TO TIME, COPIES OF WHICH ARE AVAILABLE FOR INSPECTION AT THE PRINCIPAL OFFICES
OF THE COMPANY.

WARRANT NO.             

WARRANT CERTIFICATE

TO PURCHASE SHARES OF SERIES E CONVERTIBLE PREFERRED STOCK,

PAR VALUE $0.01 PER SHARE

OF

ELECTRIC CITY CORP.

     THIS IS TO CERTIFY THAT                                                                             , a
                                      , or its registered assigns (the “Holder”), is the owner of
                    warrants (the “Warrants”), each of which entitles the registered
Holder to purchase from Electric City Corp., a Delaware corporation (the
“Company”), one fully paid, duly authorized and nonassessable share of Series E
Convertible Preferred Stock, par value $0.01 per share (the “Series E Preferred
Stock”), of the Company at any time or from time to time on or before 5:00
p.m., New York City time, on the Warrant Expiration Date, at an exercise price
of $100.00 per share, subject to adjustment from time to time as set forth
herein (the “Exercise Price”), all on the terms and subject to the conditions
hereinafter set forth.

 

 

     The number of shares of Series E Preferred Stock issuable upon exercise of
each Warrant (the “Number Issuable”) shall be determined for each Warrant by
dividing $100.00 by the Exercise Price in effect at the time of such exercise,
and is initially one (1) share of Series E Preferred Stock. Capitalized terms
used herein but not otherwise defined shall have the meanings given them in
Section 13 hereof.

     Section 1. Exercise Of Warrants. Subject to the last paragraph of this
Section 1, the Warrants evidenced hereby may be exercised, in whole or in part,
by the registered Holder hereof at any time or from time to time, on or before
5:00 p.m., New York City time, on the Warrant Expiration Date upon delivery to
the Company at the principal executive office of the Company in the United
States of America, of (a) this Warrant Certificate, (b) a written notice
stating that such Holder elects to exercise the Warrants evidenced hereby in
accordance with the provisions of this Section 1 and specifying the number of
Warrants being exercised and the name or names in which such Holder wishes the
certificate or certificates for shares of Series E Preferred Stock to be issued
and (c) payment of the Exercise Price for the shares of Series E Preferred
Stock issuable upon exercise of such Warrants, which shall be payable by any
one or any combination of the following: (i) cash or (ii) certified or official
bank check payable to the order of the Company. The documentation and
consideration delivered in accordance with clauses (a), (b) and (c) of this
paragraph above are collectively referred to herein as the “Warrant Exercise
Documentation.”

     As promptly as practicable, and in any event within two (2) Business Days
after receipt of the Warrant Exercise Documentation, the Company shall deliver
or cause to be delivered certificates representing the number of validly
issued, fully paid and nonassessable shares of Series E Preferred Stock
issuable in connection with such exercise, and if less than the full number of
Warrants evidenced hereby are being exercised, a new Warrant Certificate or
Certificates, of like tenor, for the number of Warrants evidenced by this
Warrant Certificate, less the number of Warrants then being exercised;
provided, however, that no new Warrant Certificate need be delivered if the
Warrant Expiration Date has occurred. Such exercise shall be deemed to have
been made at the close of business on the date of delivery of the Warrant
Exercise Documentation so that the Person entitled to receive shares of Series
E Preferred Stock upon such exercise shall be treated for all purposes as
having become the record holder of such shares of Series E Preferred Stock at
such time.

     The Company shall pay all expenses in connection with, and all taxes and
other governmental charges (other than income taxes of the Holder) that may be
imposed in respect of the issue or delivery of any shares of Series E Preferred
Stock issuable upon the exercise of the Warrants evidenced hereby. The Company
shall not be required, however, to pay any tax or other charge imposed in
connection with any transfer involved in the issue of any certificate for
shares of Series E Preferred Stock in any name other than that of the
registered Holder of the Warrants evidenced hereby.

     In connection with the exercise of any Warrants evidenced hereby, at the
Company’s option, no fractions of shares of Series E Preferred Stock shall be
issued, but in lieu thereof the Company may elect to pay a cash adjustment in
respect of such fractional interest in an amount equal to any such fractional
interest multiplied by $100.00 per share of Series E Preferred Stock. If more
than one such Warrant shall be exercised by the Holder thereof at the same
time, the

-2-

 

number of full shares of Series E Preferred Stock issuable on such
exercise shall be computed on the basis of the total number of Warrants so
exercised.

[NOTE: THE FOLLOWING PROVISION IS OPTIONAL AND WILL BE INCLUDED OR NOT AS EACH
PARTICIPATING INVESTOR REQUESTS IN THE SERIES E WARRANTS ISSUED TO SUCH
PARTICIPATING INVESTOR AT CLOSING.]

     Notwithstanding anything to the contrary contained herein:

     (a) The number of shares of Series E Preferred Stock that may be
acquired by the Holder upon any exercise of this Warrant (or otherwise in
respect hereof) shall be limited to the extent necessary to insure that,
following such exercise (or other issuance), the total number of shares
of Common Stock then beneficially owned by such Holder and its Affiliates
and any other Persons whose beneficial ownership of Common Stock would be
aggregated with the Holder’s for purposes of Section 13(d) of the
Exchange Act (calculated assuming conversion into shares of Common Stock
of all shares of Series E Preferred Stock held by such Holder), does not
exceed 4.999% of the total number of issued and outstanding shares of
Common Stock (including for such purpose the shares of Common Stock
issuable upon such exercise). For such purposes, beneficial ownership
shall be determined in accordance with Section 13(d) of the Exchange Act
and the rules and regulations promulgated thereunder. Each delivery of
an exercise notice hereunder will constitute a representation by the
Holder that it has evaluated the limitation set forth in this paragraph
and determined that issuance of the full number of shares of Series E
Preferred Stock requested in such exercise notice is permitted under this
paragraph. By written notice to the Company, the Holder may waive the
provisions of this paragraph but (i) any such waiver will not be
effective until the 61st day after such notice is delivered to the
Company, and (ii) any such waiver will apply only to the Holder and not
to any other holder of Warrants. This provision shall not restrict the
number of shares of Series E Preferred Stock which a Holder may receive
or beneficially own in order to determine the amount of securities or
other consideration that such Holder may receive in the event of a merger
or other business combination or reclassification involving the Company
as contemplated in Section 2 of this Warrant.

     (b) The number of shares of Series E Preferred Stock that may be
acquired by the Holder upon any exercise of this Warrant (or otherwise in
respect hereof) shall be limited to the extent necessary to insure that,
following such exercise (or other issuance), the total number of shares
of Common Stock then beneficially owned by such Holder and its Affiliates
and any other Persons whose beneficial ownership of Common Stock would be
aggregated with the Holder’s for purposes of Section 13(d) of the
Exchange Act (calculated assuming conversion into shares of Common Stock
of all shares of Series E Preferred Stock held by such Holder), does not
exceed 9.999% of the total number of issued and outstanding shares of
Common Stock (including for such purpose the shares of Series E Preferred
Stock issuable upon such exercise). For such purposes, beneficial
ownership shall be determined in accordance with Section 13(d) of the
Exchange Act and the rules and regulations promulgated thereunder. Each
delivery of an exercise notice hereunder will constitute a representation
by the Holder that it has evaluated the limitation set forth in this
paragraph and determined that issuance of the full number of

-3-

 

shares of Series E Preferred Stock requested in such exercise notice
is permitted under this paragraph. This provision shall not restrict the
number of shares of Series E Preferred Stock which a Holder may receive
or beneficially own in order to determine the amount of securities or
other consideration that such Holder may receive in the event of a merger
or other business combination or reclassification involving the Company
as contemplated in Section 2 of this Warrant.

[END OF OPTIONAL PROVISION.]

     Section 2. Adjustments.

     (a) Subdivision or Combination of Stock or Stock Dividends. In case the
Company shall at any time subdivide its outstanding shares of Series E
Preferred Stock into a greater number of shares, by split or otherwise, or
issue additional shares of Series E Preferred Stock as a dividend (other than
as a dividend in respect of the outstanding Preferred Stock in accordance with
any of the Certificates of Designations), or make any other distribution upon
any class or series of stock payable in shares of common stock or Convertible
Securities of the Company, the Exercise Price in effect immediately prior to
such subdivision shall be proportionately reduced and, conversely, in case the
outstanding shares of Series E Preferred Stock of the Company shall be combined
into a smaller number of shares, the Exercise Price in effect immediately prior
to such combination shall be proportionately increased.

     (b) Reorganization; Reclassification; Consolidation; Merger or Sale of
Assets. In case of any capital reorganization or reclassification or other
change of outstanding shares of Series E Preferred Stock (other than a change
in par value, or from par value to no par value, or from no par value to par
value, or as a result of a subdivision or combination), or in case of any
consolidation or merger of the Company with or into another Person (other than
a consolidation or merger in which the Company is the resulting or surviving
person and that does not result in any reclassification or change of
outstanding Series E Preferred Stock) (any of the foregoing, a “Transaction”),
the Company, or such successor or purchasing Person, as the case may be, shall
execute and deliver to each Holder of the Warrants evidenced hereby, at least
five (5) Business Days prior to effecting any of the foregoing Transactions, a
certificate that the Holder of each such Warrant then outstanding shall have
the right thereafter to exercise such Warrant into the kind and amount of
shares of stock or other securities (of the Company or another issuer) or
property or cash receivable upon such Transaction by a holder of the number of
shares of Series E Preferred Stock into which such Warrant could have been
exercised immediately prior to such Transaction (or, if the Series E Preferred
Stock did not participate in any such Transaction, the kind and amount of
shares of stock or other securities (of the Company or another issuer) or
property or cash receivable upon such Transaction by a holder of the number of
shares of Common Stock into which such Series E Preferred Stock could have been
converted immediately prior to such Transaction). Such certificate shall
provide for adjustments that shall be as nearly equivalent as may be
practicable to the adjustments provided for in this Section 2 and shall contain
other terms identical to the terms hereof. If, in the case of any such
Transaction, the stock, other securities, cash or property receivable thereupon
by a holder of Series E Preferred Stock (or, if applicable, by a holder of
Common Stock issuable upon conversion of the Series E Preferred Stock) includes
shares of stock or other securities of a Person other than the successor or
purchasing Persons and other than the Company, who controls

-4-

 

or is controlled by the successor or purchasing Person or who, in
connection with such Transaction, issues stock, securities, other property or
cash to holders of Series E Preferred Stock or Common Stock, then such
certificate also shall be executed by such Person, and such Person shall, in
such certificate, specifically assume the obligations of such successor or
purchasing Person and acknowledge its obligations to issue such stock,
securities, other property or cash to Holders of the Warrants upon exercise
thereof as provided above. The provisions of this Section 2(b) similarly shall
apply to successive Transactions.

     (c) Special Distributions. In the event that the Company shall declare a
dividend or make any other distribution (including, without limitation, in
cash, in notes or other debt securities or in capital stock (which shall
include, without limitation, any options, warrants or other rights to acquire
capital stock)) of the Company, whether or not pursuant to a stockholder rights
plan, “poison pill” or similar arrangement (but excluding any dividend or
distribution that results in an adjustment to the Exercise Price pursuant to
Section 2(a)) in other property or assets, to holders of Series E Preferred
Stock (a “Special Distribution”), then the Board of Directors shall set aside
the amount of such dividend or distribution that each Holder of Warrants would
have been entitled to receive had it exercised such Warrants prior to the
record date for such dividend or distribution. Upon the exercise of a Warrant
evidenced hereby, the Holder shall be entitled to receive such dividend or
distribution that such Holder would have received had such Warrant been
exercised immediately prior to the record date for such dividend or
distribution.

     Section 3. Notice of Certain Events. In case at any time or from time to
time the Company shall declare any dividend or any other distribution to the
holders of its Series E Preferred Stock or Common Stock, or shall authorize the
granting to the holders of its Series E Preferred Stock or Common Stock of
rights or warrants to subscribe for or purchase any additional shares of stock
of any class or any other right, or shall authorize the issuance or sale of any
other shares or rights that would result in an adjustment to the Exercise Price
pursuant to Section 2(a) or would result in a Special Distribution described in
Section 2(c), or there shall be any capital reorganization or reclassification
of the Series E Preferred Stock or Common Stock or consolidation or merger of
the Company with or into another Person, or any sale or other disposition of
all or substantially all the assets of the Company, or there shall be a
voluntary or involuntary dissolution, liquidation or winding up of the Company,
then, in any one or more of such cases the Company shall mail to each Holder of
the Warrants evidenced hereby at such Holder’s address as it appears on the
transfer books of the Company, as promptly as practicable but in any event at
least ten (10) Business Days prior to the applicable date hereinafter
specified, a notice stating

     (a) the date on which a record is to be taken for the purpose of
such dividend, distribution, rights or warrants or, if a record is not to
be taken, the date as of which the holders of Series E Preferred Stock or
Common Stock of record to be entitled to such dividend, distribution,
rights or warrants are to be determined,

     (b) the issue date of such dividend, distribution, rights or
warrants, and

-5-

 

     (c) the date on which such reorganization, reclassification,
consolidation, merger, sale, disposition, dissolution, liquidation or
winding up is expected to become effective.

Such notice also shall specify the date as of which it is expected that the
holders of Series E Preferred Stock or Common Stock of record shall be entitled
to exchange their Series E Preferred Stock or Common Stock for shares of stock
or other securities or property or cash deliverable upon such reorganization,
reclassification, consolidation, merger, sale, disposition, dissolution,
liquidation or winding up.

     Section 4. Certain Covenants. The Company will at all times reserve and
keep available, free from preemptive rights, out of the aggregate of its
authorized but unissued Series E Preferred Stock or its authorized and issued
Series E Preferred Stock held as treasury stock, for the purpose of enabling it
to satisfy any obligation to issue Series E Preferred Stock upon exercise of
the Warrants, the maximum number of shares of Series E Preferred Stock that may
then be deliverable upon the exercise of all outstanding Warrants. The Company
shall take all action required to increase the authorized number of shares of
Series E Preferred Stock if at any time the aggregate number of authorized but
unissued shares of Series E Preferred Stock plus any shares of Series E
Preferred Stock held as treasury stock are not sufficient to permit such
reservation or to permit the exercise of all outstanding Warrants.

     The Company or, if appointed, the transfer agent for the Series E
Preferred Stock (the “Transfer Agent”) and every subsequent transfer agent for
any shares of the Company’s capital stock issuable upon the exercise of any of
the rights of purchase aforesaid will be irrevocably authorized and directed at
all times to reserve such number of authorized shares as shall be required for
such purpose. The Company will keep a copy of this Warrant Certificate on file
with the Transfer Agent and with every subsequent transfer agent for any shares
of the Company’s capital stock issuable upon the exercise of the rights of
purchase represented hereby.

     Before taking any action that would cause an adjustment pursuant to
Section 2 hereof to reduce the Exercise Price below the then par value (if any)
of the Series E Preferred Stock, the Company will take any corporate action
that may, in the opinion of its counsel (which may be counsel employed by the
Company), be necessary in order that the Company may validly and legally issue
fully paid and nonassessable Series E Preferred Stock at the Exercise Price as
so adjusted.

     The Company covenants that all Series E Preferred Stock that may be issued
upon exercise of the Warrants will, upon issue, be validly issued, fully paid,
nonassessable, free of preemptive rights and free from all taxes, liens,
charges and security interests with respect to the issue thereof.

     Section 5. Registered Holder. The person in whose name this Warrant
Certificate is registered shall be deemed the owner hereof and of the Warrants
evidenced hereby for all purposes.

     Section 6. Transfer of Warrants. Any transfer of the rights represented
by this Warrant Certificate shall be effected by the surrender of this Warrant
Certificate, along with the

-6-

 

form of assignment attached hereto, properly completed and executed by the
registered Holder hereof, at the principal executive office of the Company in
the United States of America. Thereupon, the Company shall issue in the name
or names specified by the registered Holder hereof and, in the event of a
partial transfer, in the name of the registered Holder hereof, a new Warrant
Certificate or Certificates evidencing the right to purchase such number of
shares of Series E Preferred Stock as shall be equal to the number of shares of
Series E Preferred Stock then purchasable hereunder.

     Section 7. Restrictive Legend. Each certificate representing the Series E
Preferred Stock issued upon exercise of this Warrant shall be stamped or
otherwise imprinted with a legend in the following form (in addition to any
legend required under applicable state securities laws):

THE SECURITIES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN
REGISTERED, QUALIFIED, APPROVED OR DISAPPROVED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED, OR THE SECURITIES LAWS OF ANY
STATE AND MAY NOT BE SOLD OR OTHERWISE DISPOSED OF EXCEPT PURSUANT
TO AN EFFECTIVE REGISTRATION STATEMENT UNDER SUCH ACT AND
APPLICABLE STATE SECURITIES LAWS OR AN APPLICABLE EXEMPTION FROM
THE REGISTRATION REQUIREMENTS OF SUCH ACT OR SUCH LAWS AND NEITHER
THE UNITED STATES SECURITIES AND EXCHANGE COMMISSION NOR ANY OTHER
FEDERAL OR STATE REGULATORY AUTHORITY HAS PASSED ON OR ENDORSED
THE MERITS OF THESE SECURITIES.

THE SECURITIES REPRESENTED HEREBY ARE SUBJECT TO AN AMENDED AND
RESTATED STOCKHOLDERS AGREEMENT, AN AMENDED AND RESTATED INVESTOR
RIGHTS AGREEMENT AND AN AMENDED AND RESTATED STOCK TRADING
AGREEMENT, AS EACH OF THE SAME MAY BE AMENDED FROM TIME TO TIME,
COPIES OF WHICH ARE AVAILABLE FOR INSPECTION AT THE PRINCIPAL
OFFICES OF THE COMPANY.

Said legends shall be removed by the Company, upon the request of the holder
thereof, at such time as the restrictions on the transfer of the applicable
security under applicable securities laws and the obligations imposed on the
holder thereof under the Amended and Restated Stockholders Agreement, the
Amended and Restated Investor Rights Agreement and the Amended and/or Restated
Stock Trading Agreement, as applicable, shall have terminated.

     Section 8. Denominations. The Company will, at its expense, promptly upon
surrender of this Warrant Certificate at the principal executive office of the
Company in the United States of America, execute and deliver to the registered
Holder hereof a new Warrant Certificate or Certificates in denominations
specified by such Holder for an aggregate number of Warrants equal to the
number of Warrants evidenced by this Warrant Certificate.

-7-

 

     Section 9. Replacement of Warrants. Upon receipt of evidence satisfactory
to the Company of the loss, theft, destruction or mutilation of this Warrant
Certificate and, in the case of loss, theft or destruction, upon delivery of an
indemnity reasonably satisfactory to the Company (in the case of an insurance
company or other institutional investor, its own unsecured indemnity agreement
shall be deemed to be reasonably satisfactory), or, in the case of mutilation,
upon surrender and cancellation of such mutilated Warrant Certificate, the
Company will issue a new Warrant Certificate of like tenor for a number of
Warrants equal to the number of Warrants evidenced by this Warrant Certificate.

     Section 10. Governing Law. Except as to matters governed by the General
Corporation Law of the State of Delaware and decisions thereunder of the
Delaware courts applicable to Delaware corporations, which shall be governed by
such laws and decisions, this Warrant Certificate shall be construed and
enforced in accordance with, and the rights of the parties shall be governed
by, the laws of the State of Illinois applicable to agreements made and to be
performed entirely within such State.

     Section 11. Rights Inure to Registered Holder. The Warrants evidenced by
this Warrant Certificate will inure to the benefit of and be binding upon the
registered Holder thereof and the Company and their respective successors and
permitted assigns. Nothing in this Warrant Certificate shall be construed to
give to any Person other than the Company and the registered Holder and their
respective successors and permitted assigns any legal or equitable right,
remedy or claim under this Warrant Certificate, and this Warrant Certificate
shall be for the sole and exclusive benefit of the Company and such registered
Holder. Nothing in this Warrant Certificate shall be construed to give the
registered Holder hereof any rights as a Holder of shares of Series E Preferred
Stock or Common Stock until such time, if any, as the Warrants evidenced by
this Warrant Certificate are exercised in accordance with the provisions
hereof.

     Section 12. Notices. All notices, demands and other communications
provided for or permitted hereunder shall be made in writing and shall be given
by registered or certified first-class mail, return receipt requested,
nationally recognized overnight delivery service or personal delivery,

	 	(a)	 	if to the Holder of a Warrant, at such Holder’s last known
address appearing on the books of the Company; and
	 
	 	(b)	 	if to the Company, at its principal executive office in the
United States located at the address designated for notices in the
Redemption and Exchange Agreement,

or such other address as shall have been furnished to the party given or making
such notice, demand or other communication. All such notices and
communications shall be deemed to have been duly given: when delivered by hand,
if personally delivered; when delivered if delivered by a nationally recognized
overnight delivery service; and five (5) Business Days after being deposited in
the mail, certified or registered as aforesaid, postage prepaid, if mailed.

     Section 13. Definitions. For the purposes of this Warrant Certificate,
the following terms shall have the meanings indicated below:

-8-

 

     “Business Day” means any day other than a Saturday, Sunday or other
day on which commercial banks in the City of New York are authorized or
required by law or executive order to close.

     “Certificates of Designations” means, the Series E Certificate of
Designations.

     “Common Stock” means shares of the Company’s common stock, par value
$0.0001 per share.

     “Company” shall have the meaning set forth in the preamble hereof.

     “Convertible Securities” means any rights to subscribe for or to
purchase, or any options or warrants for the purchase of, Series E
Preferred Stock or any stock, notes or securities convertible into or
exchangeable for Series E Preferred Stock.

     “Exercise Price” shall have the meaning set forth in the preamble
hereof.

     “Holder” shall have the meaning set forth in the preamble.

     “Number Issuable” shall have the meaning set forth in the preamble.

     “Person” means any individual, corporation, limited liability
company, partnership, trust, incorporated or unincorporated association,
joint venture, joint stock company, government (or an agency or political
subdivision thereof) or other entity of any kind.

     “Preferred Stock” means shares of any of the Series E Preferred
Stock.

     “Redemption and Exchange Agreement” means that certain Redemption
and Exchange Agreement, dated as of March 19, 2004, among the Company,
the Holder and the other parties signatory thereto, as the same may be
amended, modified or otherwise supplemented from time to time in
accordance with its terms.

     “Series E Certificate of Designations” means the Certificate of
Designations, Preferences and Relative, Participating, Optional and Other
Special Rights of Preferred Stock and Qualifications, Limitations and
Restrictions Thereof of Series E Convertible Preferred Stock of Electric
City Corp., as filed with the Secretary of State of Delaware and as may
be amended and in effect from time to time.

     “Series E Preferred Stock” shall have the meaning set forth in the
preamble hereof.

     “Special Distribution” shall have the meaning set forth in Section
2(c) hereof.

     “Transaction” shall have the meaning set forth in Section 2(b)
hereof.

     “Transfer Agent” shall have the meaning set forth in Section 4
hereof.

     “Warrants” shall have the meaning set forth in the preamble hereof.

-9-

 

     “Warrant Exercise Documentation” shall have the meaning set forth in
Section 1 hereof.

     “Warrant Expiration Date” means June 27, 2004.

[Balance of page intentionally left blank; signature page follows]

-10-

 

     IN WITNESS WHEREOF, the Company has caused this Warrant Certificate to be
duly executed and delivered on March 19, 2004.

	 	 	 	 	 	 	 
	 

	 	COMPANY:
	 	 	 	ELECTRIC CITY CORP.,
	 
	 	 	 	 	 	 
	

	 	 	 	 	By:	 
	

	 	 	 	 	 	
 
	

	 	 	 	 	 	Name:John Mitola

Title:Chief Executive Officer

ATTEST:

-11-

 

Form of Assignment Form

[To be executed upon assignment of Warrants]

     The undersigned hereby assigns and transfers unto                                     ,
whose Social Security Number or Tax ID Number is                                      and whose
record address is                                      the rights represented by
the attached Warrant Certificate with respect to           Warrants to which the
attached Warrant Certificate relates, and irrevocably appoints                     
as agent to transfer this security on the books of the Company. Such agent may
substitute another to act for such agent.

	 	 	 
	

	 	Signature:
	 
	 	 
	 
	 	 
	 
	 	 
	

	 	
 
	

	 	(Signature must conform in all respects to name of holder as
specified on the face of the Warrant Certificate)
	 
	 	 
	

	 	Signature Guarantee:
	 
	 	 
	 
	 	 
	 
	 	 
	

	 	
 

Date:
   

 

 

(SUBSCRIPTION FORM TO BE EXECUTED UPON EXERCISE OF

SOME OR ALL OF THE WARRANTS)

     The undersigned, registered Holder, successor or assignee of such
registered Holder of the within Warrant Certificate, hereby:

     (a) subscribes for                    shares of Series E Preferred Stock which the
undersigned is entitled to purchase under the terms of the within Warrant
Certificate, (b) makes the full cash payment therefor called for by the
within Warrant Certificate, and (c) directs that the Series E Preferred
Stock issuable upon exercise of said Warrants be issued as described
hereunder.

	 	 	 
	

	 	
 
	

	 	(Name)
	 
	 	 
	

	 	
 
	

	 	(Address)
	 
	 	 
	

	 	
 
	

	 	SIGNATURE
	 
	 	 
	Dated:

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