Document:

Form of Omnibus Incentive Plan Restricted Stock Unit Award Agreement

 Exhibit 10.25 
 COOPER-STANDARD HOLDINGS INC. 2011 OMNIBUS INCENTIVE PLAN 
 RESTRICTED
STOCK UNIT AWARD AGREEMENT 
 THIS AGREEMENT (this “Agreement”), is made effective as of the
     day of             , 20     (the “Date of Grant”), between Cooper-Standard Holdings Inc., a Delaware
corporation (the “Company”), and the individual whose name is set forth on the signature page hereof (the “Participant”): 
 R E C I T A L S: 

WHEREAS, the Company has adopted the Cooper-Standard Holdings Inc. 2011 Omnibus Incentive Plan (the “Plan”), which Plan is
incorporated herein by reference and made a part of this Agreement. Capitalized terms not otherwise defined herein shall have the same meanings as in the Plan; and 
 WHEREAS, the Committee has determined that it would be in the best interests of the Company and its shareholders to grant the Restricted Stock Units provided for herein to the Participant pursuant to the
Plan and the terms set forth herein. 
 NOW THEREFORE, in consideration of the mutual covenants hereinafter set forth, the
parties agree as follows: 
 1. Grant. The Company hereby grants to the Participant
             Restricted Stock Units on the terms and conditions set forth in this Agreement. The Participant’s rights with respect to the Restricted Stock Units will remain
forfeitable at all times prior to the Lapse Date described in Section 3. 
 2. Restrictions on Transfer. The
Participant will not be entitled to sell, transfer, or otherwise dispose of or pledge or otherwise hypothecate or assign the Restricted Stock Units. Prior to the date on which the Restricted Stock Units are settled as provided in Section 4 (the
“Settlement Date”), the Participant will not be entitled to sell, transfer, or otherwise dispose of or pledge or otherwise hypothecate or assign the Shares underlying the Restricted Stock Units (collectively, the “Transfer
Restrictions”); provided, however, that in no event will the Participant, after the Settlement Date, be entitled to transfer, sell, pledge, hypothecate or assign the Shares issued in respect of the Restricted Stock Units except as provided for
in a stockholders agreement, if any. 
 3. Vesting; Termination of Employment. 

(a) Vesting. One hundred percent (100%) of the Restricted Stock Units shall vest and no longer be subject to
forfeiture on the third anniversary of the Date of Grant (the “Lapse Date”), subject to the Participant’s continued Employment with the Company or its Affiliate until such date. 

(b) Termination of Employment. If the Participant’s Employment with the Company and its Affiliates terminates
for any reason, the Restricted Stock Units shall, to the extent that the Lapse Date has not occurred, be canceled by the Company without consideration; provided that upon termination of the Participant’s Employment

 
by the Company and its Affiliates without Cause, by the Participant for Good Reason, or due to the Participant’s death, Disability or Retirement, then a number of Restricted Stock Units
equal to (x) the total number of Restricted Stock Units multiplied by (y) a fraction, the numerator of which is the number of the Participant’s days of employment during from the Date of Grant through the date of termination and the
denominator of which is 1,095, shall vest and no longer be subject to forfeiture as of the date of such termination, and any remaining Restricted Stock Units shall be canceled by the Company without consideration. For purposes hereof, the Restricted
Stock Units that vest upon a Participant’s termination of employment shall be paid only upon the Participant’s separation from service within the meaning of Code Section 409A. 

4. Settlement. 
 (a) General. Except as otherwise provided in Section 4(b), as soon as practicable after the Restricted Stock Units vest (but no later than two-and-one-half months from the end of the fiscal
year in which vesting occurs), the Company will settle such vested Restricted Stock Units by electing either to (a) issue in the Participant’s name a stock certificate or certificates or make an appropriate book entry for a number of
Shares equal to the number of Restricted Stock Units that have vested or (b) deliver an amount of cash equal to the Fair Market Value, determined as of the vesting date, of a number of Shares equal to the number of Restricted Stock Units that
have vested. The Transfer Restrictions applicable to the Shares issued in respect of the Restricted Stock Units shall lapse upon such issuance. 
 (b) Six-Month Delay for Specified Employees. Notwithstanding any other provision in the Plan or this Agreement to the contrary, if (i) the Restricted Stock Units become vested as a result of a
termination of the Participant’s Employment by the Company and its Affiliates for other than death, and (ii) the Participant is a “specified employee” within the meaning of Code Section 409A as of the date of such separation
from service, then settlement of such vested Restricted Stock Units shall occur on the date that is six months after the date of the Participant’s separation from service. 

(c) Stock Certificate Restrictions. The Company shall not be liable to the Participant for damages relating to any
delays in issuing any stock certificates hereunder to the Participant, any loss of any such certificates, or any mistakes or errors in the issuance of such certificates or in such certificates themselves; provided that the Company shall correct any
such errors caused by it. Any such certificate or certificates shall be subject to such stop transfer orders and other restrictions as the Committee may deem advisable under the Plan or the rules, regulations, and other requirements of the
Securities and Exchange Commission, any stock exchange upon which such Shares are listed, and any applicable Federal or state laws, and the Committee may cause a legend or legends to be put on any such certificates to make appropriate reference to
such restrictions. 
 5. Dividends and Voting Rights. Subject to Section 11, the Participant shall not have voting
rights with respect to the Shares underlying the Restricted Stock Units unless and 

  
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until such Shares are reflected as issued and outstanding shares on the Company’s stock ledger. The Participant shall receive a cash payment equivalent to any dividends or other
distributions paid with respect to the shares of Common Stock underlying the Restricted Stock Units, so long as the applicable record date occurs on or after the Date of Grant and before such Restricted Stock Units are forfeited. If, however, any
dividends or distributions with respect to the Shares underlying the Restricted Stock Units are paid in Shares rather than cash, then the Participant shall be credited with additional restricted stock units equal to the number of Shares that the
Participant would have received had the Restricted Stock Units been actual Shares, and such restricted stock units shall be deemed Restricted Stock Units subject to the same risk of forfeiture and other terms of this Agreement and the Plan as apply
to the other Restricted Stock Units granted under this Award. Any amounts due to the Participant under this provision shall be paid to the Participant or distributed, as applicable, at the same time as payment is made in respect of the Restricted
Stock Units granted under this Agreement. 
 6. No Right to Continued Employment. The granting of the Restricted Stock
Units evidenced hereby and this Agreement shall impose no obligation on the Company or any of its Affiliates to continue the Employment of the Participant and shall not lessen or affect the Company’s or its Affiliate’s right to terminate
the Employment of the Participant. 
 7. Withholding. The Participant may be required to pay to the Company or any
Affiliate, and the Company and its Affiliates shall have the right and are hereby authorized to withhold, any applicable withholding taxes in respect of the Restricted Stock Units or any transfer under or with respect to the Restricted Stock Units
and to take such other action as may be necessary in the opinion of the Committee to satisfy all obligations for the payment of such withholding taxes. 
 8. Securities Laws. Upon the acquisition of any Shares pursuant to the Restricted Stock Units, the Participant will make or enter into such written representations, warranties and agreements as the
Committee may reasonably request in order to comply with applicable securities laws or with this Agreement. 
 9.
Notices. Any notice necessary under this Agreement shall be addressed to the Company in care of its Secretary at the principal executive office of the Company and to the Participant at the address appearing in the personnel records of the
Company for the Participant or to either party at such other address as either party may hereafter designate in writing to the other. Any such notice shall be deemed effective upon receipt thereof by the addressee. 

10. Choice of Law. THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF DELAWARE
WITHOUT REGARD TO CONFLICTS OF LAWS.  
 11. Restricted Stock Units Subject to Plan. By entering into this Agreement,
the Participant agrees and acknowledges that the Participant has received and read a copy of the Plan. The Restricted Stock Units are subject to the Plan. The terms and provisions of the Plan as they may be amended from time to time are hereby
incorporated herein by reference. In the event of a conflict between any term or provision contained herein and a term or provision of the Plan, the applicable terms and provisions of the Plan will govern and prevail. 

  
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 12. Signature in Counterparts. This Agreement may be signed in counterparts, each of
which shall be an original, with the same effect as if the signatures thereto and hereto were upon the same instrument. 

  
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 IN WITNESS WHEREOF, the parties hereto have executed this Agreement. 

 

			
	COOPER-STANDARD HOLDINGS INC.
		
	By:	 	  

 

	
	Agreed and acknowledged as of the date first above written:
	
	  

	Participant:                     

Restricted Stock Units:             
                     

  
 5Form of Restricted Stock Award Agreement

 Exhibit 10.1 
 AFFIRMATIVE INSURANCE HOLDINGS, INC. 
 RESTRICTED STOCK AWARD AGREEMENT

 This Restricted Stock Award Agreement (this “Agreement”), made as of the     
day of March, 2011 (the “Grant Date”) by and between Affirmative Insurance Holdings, Inc. (the “Company”), and
                     (the “Grantee”), evidences the grant by the Company of a stock award (the “Award”) of
restricted Common Stock, par value $0.01 per share (the “Common Stock”) to the Grantee on such date and the Grantee’s acceptance of the Award in accordance with the provisions of the Company’s 2004 Stock Incentive Plan
(the “Plan”), a copy of which is attached hereto as Exhibit A. 
 NOW, THEREFORE, in
consideration of the premises and the benefits to be derived from the mutual observance of the covenants and promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the parties hereto
agree as follows: 
 1. Basis for Award. This Award is made pursuant to the Plan for services rendered to the Company by
the Grantee. 
 2. Amount of Award. The Company hereby awards and grants to Grantee __________ shares of Common Stock
which shall be subject to the restrictions and conditions set forth in the Plan and in this Agreement (the “Restricted Stock”). 
 3. Vesting. The Restricted Stock will vest subject to both performance and time thresholds. 
 (a) Performance Vesting. The Restricted Stock will vest subject to Common Stock per share price thresholds over a four-year time period (“Performance Vesting”). If the
Company’s Common Stock does not reach and sustain a given per share price threshold for twenty consecutive trading days by the end of the period for that price threshold, except as described below, the Restricted Stock subject to that price
threshold will not vest. The Restricted Stock will vest on the applicable anniversary of the Grant Date according to the following per share price thresholds and subject to the Time Vesting described below in Section 3(b): 

(i) One-third of the Award will vest on the eighteen (18) month anniversary of the Grant Date, subject to a share
price threshold of $5.00 within eighteen (18) month of the Grant Date; 
 (ii) One-third of the Award will
vest on the three (3) year anniversary of the Grant Date, subject to a share price threshold of $10.00 within three years of the Grant Date; 
 (iii) One-third of the Award will vest on the four (4) year anniversary of the Grant Date, subject to a share price threshold of $15.00 within four years of the Grant Date, provided, however, that
for a share price threshold of between $13.00 and $15.00, the following special vesting percentages will apply: 

(1) For a share price of $13.00, only 60% of the Restricted Stock subject to this paragraph (iii) will vest; and

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 1	  

 (2) For a share price of between $13.00 and $15.00, a prorated percent of
the Restricted Stock subject to this paragraph (iii) will vest (e.g., if the share price reaches $14.00 at the end of the fourth year, then 80% of the Restricted Stock subject to the $15.00 price threshold will vest). 

(iv) Additional Vesting of Unvested Shares. If, on the fourth anniversary of the Grant Date, the Company’s
Common Stock has reached a per share price of $15.00 for twenty consecutive trading days, then 80% of any Restricted Stock that did not previously vest because the associated per share price threshold was not met will vest, subject to the Time
Vesting described below in Section 3(b). 
 (b) Time Vesting. 

(i) Subject to the above Performance Vesting, the Restricted Stock will vest 20% per year beginning on the first
anniversary of the Grant Date, provided the Grantee remains employed with the Company (“Time Vesting”). Vesting will not occur for any portions of the Award that have not satisfied the above performance vesting price thresholds.

 (ii) Accelerated Vesting. Notwithstanding the foregoing: 

(1) Should Grantee be terminated without Cause within one year of the Company completing a merger in which greater than
50% of the surviving entity represents shareholders who were not shareholders of the Company prior to the consummation of the transaction, Grantee will be entitled to an additional 50% of Time Vesting (vested percentage plus accelerated vesting
capped at 100%); 
 (2) Should Grantee be terminated without Cause or due to death or Disability, Grantee shall
be entitled to an additional 20% of Time Vesting (vested percentage plus accelerated vesting capped at 100%). 
 4.
Stockholder Rights. Subject at all times to the Company’s option to repurchase Grantee’s shares of Restricted Stock as set forth in Section 6 of this Agreement, Grantee shall have voting (and all other) rights attendant to the
ownership of shares of Common Stock with respect to the Restricted Stock but shall not be eligible to receive cash dividends paid on the Restricted Stock unless and until such Restricted Stock vests. Cash dividends paid on unvested Restricted Stock
will accumulate and be paid to Grantee within 60 days after the related Restricted Stock vests, subject to approval of the Compensation Committee of the Board of Directors of the Company. 

5. Voting Proxy. As a condition precedent to the Company’s issuance of the Restricted Stock to Grantee, Grantee acknowledges
and agrees that Grantee will execute an 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 2	  

 
irrevocable voting proxy for the benefit of New Affirmative, LLC contemporaneously with the execution of this Agreement and the acceptance of this Award, wherein such proxy will afford New
Affirmative, LLC the right to vote Grantee’s shares of Restricted Stock for a duration of time and on the terms and conditions set forth therein. 
 6. Option to Purchase Shares. The Company shall have the option to purchase some or all of the fully-vested shares of Grantee’s Restricted Stock (the “Purchase
Option”): (i) if Grantee should voluntarily elect to sell some or all of the fully-vested shares of Grantee’s Restricted Stock during Grantee’s employment with the Company or during the term of Grantee’s service on
the Company’s Board of Directors, or (ii) upon the later to occur of Grantee’s termination of: (a) employment or (b) service on the Company’s Board of Directors. If Grantee elects to sell some or all of Grantee’s
fully-vested shares of Restricted Stock while Grantee is employed by the Company or serving as a member of the Company’s Board of Directors, Grantee shall provide written notice to the Company specifying the number of shares of such stock that
Grantee desires to sell and expressly requesting clearance to sell said shares in accordance with the Company’s internal stock trading policies as in effect at the time of Grantee’s desired trade (“Grantee’s Sale
Notice”). The Company shall have up to five (5) calendar days from and after its receipt of Grantee’s Sale Notice to consider Grantee’s request to trade, and (provided that said trade is authorized in accordance with the
Company’s current internal stock trading policies) exercise its Purchase Option with respect to some or all of the shares referenced in Grantee’s Sale Notice by providing Grantee with written notice of the Company’s intent to
effectuate such purchase (the “Company Purchase Notice”). Upon the later to occur of Grantee’s termination of: (a) employment or (b) service on the Company’s Board of Directors, the Company shall have up
to five (5) calendar days from and after Grantee’s termination date to exercise its Purchase Option for up to all of the fully-vested shares of Restricted Stock then held by Grantee by providing Grantee with a Company Purchase Notice. Any
Company Purchase Notice shall specify whether the Company is exercising its Purchase Option with respect to all or a lesser number of vested shares of Restricted Stock than are set forth in Grantee’s Sale Notice or, in the case of
Grantee’s termination, whether the Company is exercising its Purchase Option with respect to all or a lesser number of Grantee’s vested shares of Restricted Stock. If the Company does not elect to exercise its Purchase Option with respect
to all vested shares of Restricted Stock that are the subject of Grantee’s Sale Notice or less than all of the total number of vested shares of Grantee’s Restricted Stock upon Grantee’s termination, the Company’s Purchase Option
with respect to those shares that it is not exercising its right to acquire shall expire at the end of the five (5) calendar day period referenced in this Section 6. Further, the Company’s Purchase Option under this Section 6
shall terminate immediately if the voting proxy referenced in Section 5 of this Agreement terminates on the terms and conditions set forth in any such proxy. 
 The purchase price for any shares of Restricted Stock purchased by the Company under this Section 6 shall be equal to: (A) the per share closing price for the Company’s Common Stock on the
NASDAQ Stock Market on the date of: (1) the Company’s receipt of Grantee’s Sale Notice or (2) Grantee’s termination (as applicable), multiplied by (B) the number of shares of Restricted Stock being purchased from
Grantee (the “Purchase Price”). The Company shall also pay any accrued and unpaid dividends on any vested shares of Grantee’s Restricted Stock as of the date Grantee’s Sale Notice is received by the Company or
Grantee’s termination date (“Accrued Dividends”) to Grantee in addition to the Purchase Price. The Company shall pay the Purchase Price and any Accrued Dividends to Grantee within two (2) business days after the
Company has delivered its Company Purchase Notice to Grantee. 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 3	  

 7. Compliance with Laws and Regulations. The issuance and transfer of Common Stock
shall be subject to compliance by the Company and Grantee with all applicable requirements of federal and state securities laws and with all applicable requirements of any stock exchange on which the Company’s Common Stock may be listed at the
time of such issuance or transfer. Grantee understands that the Company is under no obligation to register or qualify the Common Stock with the SEC, any state securities commission or any stock exchange to effect such compliance. 

8. Tax Withholding. 
 (a) Grantee agrees that, subject to Section 8(b) below, no later than the first to occur of (i) the date as of which the restrictions on the Restricted Stock shall lapse with respect to any of
the Restricted Stock covered by this Agreement or (ii) the date required by Section 8(b) below, Grantee shall pay to the Company (in cash or to the extent permitted by the Board, Company stock held by the Grantee whose Fair Market Value on
the date the Restricted Stock vests is equal to the amount of Grantee’s tax withholding liability) any federal, state or local taxes of any kind required by law to be withheld, if any, with respect to the Restricted Stock for which the
restrictions shall lapse. The Company shall, to the extent permitted by law, have the right to deduct from any payment of any kind otherwise due to Grantee any federal, state or local taxes of any kind required by law to be withheld with respect to
the shares of such Restricted Stock. 
 (b) Grantee agrees to properly elect, within thirty (30) days of the
Grant Date, to include in gross income for federal income tax purposes an amount equal to the Fair Market Value of the Restricted Stock granted hereunder pursuant to Section 83(b) of the Internal Revenue Code of 1986, as amended, Grantee shall
pay to the Company, or make other arrangements satisfactory to the Board to pay to the Company on the date of such grant, any federal, state or local taxes required to be withheld with respect to such Restricted Stock. If Grantee fails to make such
payments, the Company shall, to the extent permitted by law, have the right to deduct from any payment of any kind otherwise due to Grantee any federal, state or local taxes of any kind required by law to be withheld with respect to such Restricted
Stock. 
 9. No Right to Continued Service. Nothing in this Agreement shall be deemed by implication or otherwise to
impose any limitation on any right of the Company to terminate the Grantee’s service at any time. In the event Grantee’s employment with the Company is terminated, except as stated otherwise in Section 3 above, no unvested shares of
Common Stock shall become vested after such termination of employment. 
 10. Representations and Warranties of Grantee.
Grantee represents and warrants to the Company that: 
 (a) Agrees to Terms of the Plan. Grantee has
received a copy of the Plan and has read and understands the terms of the Plan and this Agreement, and agrees to be 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 4	  

 
bound by their terms and conditions. Grantee acknowledges that there may be adverse tax consequences upon the vesting of Restricted Stock or disposition of the Common Stock once vested, and that
Grantee should consult a tax advisor prior to such time. 
 (b) Stock Ownership. Grantee is the record and
beneficial owner of the shares of Restricted Stock with full right and power to transfer the Unvested Shares (as defined in Section 11) to the Company free and clear of any liens, claims or encumbrances and Grantee understands that the stock
certificates evidencing the Restricted Stock will bear a legend referencing this Agreement. 
 (c) Voting
Proxy. Grantee has executed an irrevocable proxy together with this Agreement on the Grant Date, and said proxy has granted New Affirmative, LLC the right to vote all of Grantee’s shares of Restricted Stock for a duration of time and on the
terms and conditions set forth therein. 
 (d) SEC Rule 144. Grantee understands that Rule 144 promulgated
under the Securities Act may indefinitely restrict transfer of the Common Stock so long as Grantee remains an “affiliate” of the Company or if “current public information” about the Company (as defined in Rule 144) is not
publicly available. 
 11. Compliance with U.S. Federal Securities Laws. Grantee understands and acknowledges that
notwithstanding any other provision of the Agreement to the contrary, the vesting and holding of the Restricted Stock is expressly conditioned upon compliance with the Securities Act and all applicable state securities laws. Grantee agrees to
cooperate with the Company to ensure compliance with such laws. 
 12. Forfeiture of Unvested Stock. In the event that
shares of unvested Restricted Stock (“Unvested Shares”) standing the in name of Grantee on the books of the Company do not become vested on or before the expiration of the period during which the applicable vesting conditions must
occur, such Unvested Shares shall be automatically forfeited and cancelled as outstanding shares of Restricted Stock immediately upon the occurrence of the event or time period after which such Unvested Shares may no longer become vested.

 13. Restrictions on Unvested Shares. 

(a) Deposit of the Unvested Shares. Grantee shall deposit all of the Unvested Shares with the Company to hold until
the Unvested Shares become vested, at which time such vested shares shall no longer constitute Unvested Shares. The Company will deliver to Grantee the shares of Common Stock that become vested upon vesting of such shares. Grantee shall execute and
deliver to the Company, concurrently with the execution of this Agreement blank stock powers for use in connection with the transfer to the Company or its designee of Unvested Shares that do not become vested. 

(b) Restriction on Transfer of Unvested Shares. Grantee shall not transfer, assign, grant a lien or security
interest in, pledge, hypothecate, encumber or otherwise dispose of any of the Unvested Shares, except as permitted by this Agreement. 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 5	  

 14. Adjustments. The number of Unvested Shares shall be automatically adjusted to
reflect any stock split, stock dividend, recapitalization, merger, consolidation, reorganization, combination or exchanges of shares or other similar event affecting the Company’s outstanding Common Stock subsequent to the date of this
Agreement. If Grantee becomes entitled to receive any additional shares of Common Stock or other securities (“Additional Securities”) under this Section, the total number of Unvested Shares shall be equal to the sum of (i) the
initial Unvested Shares; and, (ii) the number of Additional Securities issued or issuable in respect of the initial Unvested Shares and any Additional Securities previously issued to Grantee. 

15. Restrictive Legends and Stop-Transfer Orders. 

(a) Legends. Grantee understands and agrees that the Company will place the legends set forth below or similar
legends on any stock certificate(s) evidencing the Common Stock, together with any other legends that may be required by state or U.S. Federal securities laws, the Company’s Certificate of Incorporation or Bylaws, any other agreement between
Grantee and the Company or any agreement between Grantee and any third party: 
 THE SHARES REPRESENTED BY THIS CERTIFICATE
ARE SUBJECT TO CERTAIN RESTRICTIONS ON PUBLIC RESALE AND TRANSFER, AS SET FORTH IN A RESTRICTED STOCK AWARD AGREEMENT BETWEEN THE ISSUER AND THE ORIGINAL HOLDER OF THESE SHARES. SUCH PUBLIC SALE AND TRANSFER RESTRICTIONS ARE BINDING ON TRANSFEREES
OF THESE SHARES. 
 (b) Stop-Transfer Instructions. Grantee agrees that, to ensure compliance with the
restrictions imposed by this Agreement, the Company may issue appropriate “stop-transfer” instructions to its transfer agent, if any, and if the Company transfers its own securities, it may make appropriate notations to the same effect in
its own records. 
 (c) Refusal to Transfer. The Company will not be required (i) to transfer on its
books any shares of Common Stock that have been sold or otherwise transferred in violation of any of the provisions of this Agreement or (ii) to treat as owner of such shares, or to accord the right to vote or pay dividends to any purchaser or
other transferee to whom such shares have been so transferred. 
 16. Modification. The Agreement may not be modified
except in writing signed by both parties. 
 17. Plan. Except as otherwise provided herein, or unless the context clearly
indicates otherwise, capitalized terms herein which are defined in the Plan have the same definitions as provided in the Plan. The terms and provisions of the Plan are incorporated herein by references, and the Grantee hereby acknowledges receiving
a copy of the Plan. In the event of a conflict or inconsistency between the terms and provisions of the Plan and the provisions of this Agreement, the Plan shall govern and control. 

18. Interpretation. Any dispute regarding the interpretation of this Agreement shall be submitted by Grantee or the Company to the
administrator of the Plan (“Plan Administrator”) for review. The resolution of such a dispute by the Plan Administrator shall be final and binding on the Company and Grantee. 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 6	  

 19. Entire Agreement. The Plan is incorporated herein by reference. This Agreement
and the Plan constitute the entire agreement of the parties and supercede all prior undertakings and agreements with respect to the subject matter hereof. If any inconsistency should exist between the nondiscretionary terms and conditions of this
Agreement and the Plan, the Plan shall govern and control. 
 20. Notices. Any notice required to be given or delivered
to the Company under the terms of this Agreement shall be in writing and addressed to the Corporate Secretary of the Company at its principal corporate offices. Any notice required to be given or delivered to Grantee shall be in writing and
addressed to Grantee at the address indicated on the signature page hereof or to such other address as such party may designate in writing from time to time to the Company. All notices shall be deemed to have been given or delivered upon:
(a) personal delivery and/or receipt; (b) three (3) days after deposit in the United States mail by certified or registered mail (return receipt requested); (c) one (1) business day after deposit with any return receipt
express courier (prepaid); or (d) one (1) business day after transmission by facsimile, e-mail or telecopier. 
 21.
Successors and Assigns. The Company may assign any of its rights under this Agreement. This Agreement shall be binding upon and inure to the benefit of the successors and assigns of the Company. Subject to the restrictions on transfer set
forth herein, this Agreement shall be binding upon Grantee and Grantee’s heirs, executors, administrators, legal representatives, successors and assigns. 
 22. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Delaware without giving effect to its conflict of law principles. If any provision
of this Agreement is determined by a court of law to be illegal or unenforceable, then such provision will be enforced to the maximum extent possible and the other provisions will remain fully effective and enforceable. 

23. Acceptance. Grantee hereby acknowledges receipt of a copy of the Plan and this Agreement. Grantee has read and understands the
terms and provisions thereof, and accepts the Award subject to all the terms and conditions of the Plan and this Agreement. Grantee acknowledges that there may be adverse tax consequences upon exercise of the Award or disposition of the Shares and
that Grantee should consult a tax advisor prior to such exercise or disposition. 
 [SIGNATURE PAGE FOLLOWS] 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 7	  

 IN WITNESS WHEREOF, the parties hereto have signed this Agreement as of the date
first above written. 
  

			
	AFFIRMATIVE INSURANCE HOLDINGS, INC.
		
	By:	 	  

			
	Name:	 	  

			
	Title:	 	  

			
		
	GRANTEE	 	
	
	  

		
	Address:	 	  

		 	  

		 	  

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 8	  

 EXHIBIT A 
 Affirmative Insurance Holdings, Inc. 2004 Stock Incentive Plan 

  

					
	Affirmative Insurance Holdings, Inc. Restricted Stock Award Agreement	  	 	Page 9

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