MAGNETECH INTEGRATED SERVICES CORP. PLACEMENT AGENCY AGREEMENT
Exhibit
10.2
MAGNETECH
INTEGRATED SERVICES CORP.
Strasbourger
Xxxxxxx Tulcin Xxxxx Incorporated
00
Xxxxxxxxx Xxxxxx, 00xx
Xxxxx
Xxx
Xxxx,
Xxx Xxxx 00000
January
25, 2005
Ladies
and Gentlemen:
This
Placement Agency Agreement (this “Agreement”)
confirms the retention by Magnetech Integrated Services Corp., an Indiana
corporation (“MISC”
or the
“Company”), of Strasbourger Xxxxxxx Tulcin Xxxxx Incorporated, a New York
corporation (“Strasbourger”
or the
“Placement Agent”),
to
act as the sales agent, on a best efforts basis, in connection with the
Placement (as defined below) for MISC, on the terms set forth below.
MISC
proposes to offer and sell solely to “accredited investors,” as such term is
defined in Rule 501 promulgated under the Securities Act of 1933, as amended
(the “1933
Act”),
a
Private Placement Offering (the “PPO” or the “Placement”) of up to $4,000,000 in
principal amount of its Subordinated Secured Convertible Debentures (the
“Debentures”) at par. The PPO offering will be made on a “best efforts,
$1,000,000 or none” basis with respect to the first $1,000,000 principal amount
of Debentures, and on a “best efforts, any or all” basis with respect to the
remaining $3,000,000 principal amount will be offered in accordance with
Section
4(2) of the 1933 Act and Regulation D promulgated thereunder. The Debentures
will be convertible into a maximum of 11,747,685 shares of common stock of
MISC,
subject to adjustment in certain circumstances. Subscribers (as defined below)
in the Placement will be issued, for no additional consideration, common
stock
purchase warrants (“Subscriber Warrants”) to purchase a maximum of 4,229,166
shares of common stock of MISC.
The
Private Placement Memorandum to be used in connection with the PPO (the
“Memorandum”),
as it
may be amended or supplemented from time to time, and the form of proposed
debenture purchase agreement (the “Debenture
Purchase Agreement”)
between the Company and each subscriber for the Placement (the “Subscribers”)
and
the exhibits which are part of the Memorandum and/or Debenture Purchase
Agreement are collectively referred to herein as the “Offering
Documents.”
The
Offering Documents, together with (i) this Agreement, (ii) the Fund Escrow
Agreement (as defined in Section 3(b)(xii) hereof), (iii) the Agent’s Warrants
(as defined in Section 3(d) hereof) and (iv) any exhibits, schedules and
appendices which are part of the Offering Documents, and the Agency Agreement
are collectively referred to herein as the “Transaction
Documents.”
The
shares of common stock of MISC issuable upon conversion of the Debentures,
the
Subscriber Warrants and the Agents Warrants are referred to herein as the
“Underlying
Shares.”
The
Debentures, the Subscriber Warrants, the Agent’s Warrants, the Agent’s Shares
(as defined in Section 3(d) hereof) and the Underlying Shares are collectively
referred to herein as the “Securities.”
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The
Company will deliver to Strasbourger a reasonable number of copies of the
Transaction Documents in form and substance satisfactory to Strasbourger
and its
counsel.
Each
Subscriber will be required to deliver, among other things, a Debenture Purchase
Agreement and a Confidential Investor Questionnaire (the “Questionnaire”)
in the
form to be provided to offerees. An example of the Questionnaire is attached
as
Exhibit A.
1. Appointment
of Placement Agent.
Strasbourger
is hereby appointed or ratified, as the case may be, as exclusive placement
agent of the Company (subject to Strasbourger’s right to have selected dealers
(“Selected
Dealers”)
in
good standing with the National Association of Securities Dealers (“NASD”)
participate in the Placement) during the offering period for the Placement
herein specified for the purposes of assisting the Company in finding qualified
Subscribers. The offering period for the PPO (the “PPO
Period”)
shall
commence January 25, 2005, which is the day the Offering Documents are first
made available to the Placement Agent by the Company for delivery in connection
with the PPO (the “Delivery
Date”)
and
shall continue until the earlier to occur of: (i) the sale of all of the
Debentures; or (ii) April 29, 2005, which is 90 days following the Delivery
Date. The day that the PPO Period terminates is hereinafter referred to as
the
“PPO
Termination Date.”
The
PPO Termination Date may be extended for up to 45 days at the option of the
Placement Agent and the Company.
(a) Subject
to the performance by the Company of all of its obligations to be performed
under this Agreement and to the completeness and accuracy of all representations
and warranties of the Company contained in this Agreement, the Placement
Agent
hereby accepts such agency and agrees to use its best efforts to assist the
Company in finding qualified Subscribers. It is understood that the Placement
Agent has no commitment to sell the Debentures. Strasbourger’s agency hereunder
is not terminable by the Company except upon termination of the PPO Offering
Period.
(b) Subscriptions
for Debentures shall be evidenced by the execution by Subscribers of a Debenture
Purchase Agreement. No Debenture Purchase Agreement shall be effective unless
and until it is accepted and countersigned by the Company. The Placement
Agent
shall not have any obligation to independently verify the accuracy or
completeness of any information contained in any Debenture Purchase Agreement
or
the authenticity, sufficiency, or validity of any check delivered by any
prospective Subscriber in payment for Debentures.
(c) The
Placement Agent and/or its affiliates may be Subscribers in the
Placement.
2. Representations
and Warranties of the Company.
Except
as set forth in the Transaction Documents or in the Disclosure Schedule attached
hereto, the Company represents and warrants to the Placement Agent and each
Selected Dealer, if any, as follows:
(a) Securities
Law Compliance.
The
offer, offer for sale, and sale of the Securities have not been registered
with
the United States Securities and Exchange Commission (the “SEC”).
The
Securities are to be offered, offered for sale and sold in reliance upon
the
exemptions from the registration requirements of Section 5 of the 1933 Act.
The
Company will conduct the
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Placement
in compliance with the requirements of Regulation D of the General Rules
and
Regulations under the 1933 Act, and the Company will file all appropriate
notices of offering with the SEC. The Company has prepared the Offering
Documents. None of the representations or warranties of the Company contained
in
this Agreement or any information appearing in any of the Transaction Documents
contains, or on or prior to any Closing will contain, any untrue statement
of a
material fact or omit to state any material fact necessary in order to make
the
statements therein, in light of the circumstances in which they were made,
not
misleading. If at any time prior to the completion of the Placement or other
termination of this Agreement any event shall occur as a result of which
it
might become necessary to amend or supplement the Offering Documents so that
they do not include any untrue statement of any material fact or omit to
state
any material fact necessary in order to make the statements therein, in the
light of the circumstances then existing, not misleading, the Company will
promptly notify the Placement Agreement and will supply the Placement Agreement
with amendments or supplements correcting such statement or omission. The
Company will also provide the Placement Agent for delivery to all offerees
and
purchasers and their representatives, if any, any information, documents
and
instruments which the Placement Agent deems reasonably necessary to comply
with
applicable state and federal law.
(b) Organization.
The
Company is duly organized and validly existing under the laws of the
jurisdiction in which it was organized, and has the requisite power and
authorization to own its properties and to carry on its business as now being
conducted. The Company is duly qualified as a foreign corporation to do business
and is in good standing in every jurisdiction in which its ownership of property
or the nature of the business conducted by it makes such qualification
necessary, except to the extent that the failure to be so qualified or be
in
good standing would not have a Material Adverse Effect. As used in this
Agreement, “Material
Adverse Effect”
means
any event or change in circumstance, whether or not directly or indirectly
caused by management or arising independently of management’s control, that has
or could reasonably be deemed by the Placement Agent to have in the future,
a
material adverse effect on the business, properties, assets, operations,
results
of operations, financial condition or prospects of the Company or on the
transactions contemplated hereby, or on the other Transaction Documents or
the
agreements and instruments to be entered into in connection herewith or
therewith, or on the authority or ability of the Company to perform its
obligations under the Transaction Documents.
(c) Capitalization.
As of
the date hereof, the authorized, issued and outstanding capital stock of
the
Company will be as set forth on Schedule 2(c) attached hereto. Following
the
completion of the PPO, except as set forth on Schedule 2(c), (i) no shares
of
the Company’s capital stock will be subject to preemptive rights or any other
similar rights or any liens or encumbrances suffered or permitted by the
Company; (ii) there will be no outstanding debt securities issued by the
Company, other than the Debentures; (iii) there will be no outstanding options,
warrants, scrip, rights to subscribe to, calls or commitments of any character
whatsoever relating to, or securities or rights convertible into or exchangeable
for, any shares of capital stock of the Company, or contracts, commitments,
understandings or arrangements by which the Company is or may become bound
to
issue additional shares of capital stock of the Company or options, warrants,
scrip, rights to subscribe to, calls or commitments of any character whatsoever
relating to, or securities or rights convertible into or exchangeable for,
any
shares of capital stock
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of
the
Company; (iv) there will be no outstanding securities of the Company which
contain any redemption or similar provisions, and there will be no contracts,
commitments, understandings or arrangements by which the Company will be
or may
become bound to redeem a security of the Company ; and (v) the Company will
not
have any stock appreciation rights or “phantom stock” plans or agreements or any
similar plan or agreement. All prior sales of securities of the Company will
be
either registered under the 1933 Act and applicable state securities laws
or
exempt from such registration, and no security holder will have any rescission
rights with respect thereto.
(d) Subsidiaries
and Investments.
Except
as set forth on Schedule 2(d), following the sale of the Debentures and the
completion of the PPO, the Company will not have any subsidiaries other than
Magnetech Industrial Services, Inc. and Xxxxxxx Electric, LLC, and the Company
will not own, directly or indirectly, any capital stock or other equity
ownership or proprietary interests in any other corporation, association,
trust,
partnership, joint venture or other entity.
(e) Financial
Statements.
The
Company’s financial statements attached hereto as Schedule 2(e) will fairly
present in all material respects the financial position of the Company as
of
December 31, 2004 and the results of its operations and cash flows for the
period then ended December 31, 2004 (subject to normal year-end adjustments
that
will not be material).
(f) Absence
of Changes.
Since
the date (the “Balance
Sheet Date”)
of the
most recent balance sheet provided to the Placement Agent (the “Balance
Sheet”)
and
except as set forth on Schedule 2(f) or Schedule 2(c), the Company has not
(i)
incurred any debts, obligations or liabilities, absolute, accrued, contingent
or
otherwise, whether due or to become due, except current liabilities incurred
in
the usual and ordinary course of business and consistent with past practices,
having individually or in the aggregate a Material Adverse Effect, (ii) made
or
suffered any material changes in its contingent obligations by way of guaranty,
endorsement (other than the endorsement of checks for deposit in the usual
and
ordinary course of business), indemnity, warranty or otherwise, (iii) discharged
or satisfied any material liens other than those securing, or paid any
obligation or liability other than, current liabilities shown on the Balance
Sheet, and current liabilities incurred since the Balance Sheet Date, in
each
case in the usual and ordinary course of business and consistent with past
practices, (iv) mortgaged, pledged or subjected to lien any of its material
assets, tangible or intangible, (v) sold, transferred or leased any of its
material assets except in the usual and ordinary course of business and
consistent with past practices, (vi) cancelled or compromised any debt or
claim,
or waived or released any right, of material value except in the usual and
ordinary course of business and consistent with past practices, (vii) suffered
any physical damage, destruction or loss (whether or not covered by insurance)
materially adversely affecting the properties or business of the Company,
(viii)
entered into any material transaction other than in the usual and ordinary
course of business except for this Agreement, the other Transaction Documents
and the related agreements referred to herein and therein, (ix) encountered
any
material labor difficulties or labor union organizing activities, (x) made
or
granted any wage or salary increase or entered into any employment agreement
other than in the ordinary course of business, (xi) issued or sold any shares
of
capital stock or other securities or granted any options with respect thereto,
or modified any equity security of the Company, (xii) declared or paid any
dividends on or made any other distributions with respect
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to,
or
purchased or redeemed, any of its outstanding equity securities, (xiii) suffered
or experienced any change in, or condition affecting, its condition (financial
or otherwise), properties, assets, liabilities, business operations, or results
of operations other than changes, events or conditions in the usual and ordinary
course of its business and consistent with past practices, having (either
by
itself or in conjunction with all such other changes, events and conditions)
a
Material Adverse Effect, (xiv) made any change in the accounting principles,
methods or practices followed by it or depreciation or amortization policies
or
rates theretofore adopted, or (xv) entered into any agreement, or otherwise
obligated itself, to do any of the foregoing.
(g) Title.
Except
as set forth on Schedule 2(g), the Company has good and marketable title
to all
properties and assets owned by it, free and clear of all liens, charges,
encumbrances or restrictions, except such as will not be significant or
important in relation to the Company’s business; to the Company’s knowledge, all
of the material leases and subleases under which the Company is the lessor
or
sublessor of properties or assets or under which the Company holds properties
or
assets as lessee or sublessee will be in full force and effect, and the Company
will not be in default in any material respect with respect to any of the
terms
or provisions of any of such leases or subleases, and no material claim will
have been asserted by anyone adverse to rights of the Company as lessor,
sublessor, lessee or sublessee under any of the leases or subleases mentioned
above, or affecting or questioning the right of the Company to continued
possession of the leased or subleased premises or assets under any such lease
or
sublease.
(h) Proprietary
Rights.
Except
as set forth on Schedule 2(h),the Company directly or indirectly owns or
possesses exclusive and enforceable rights to use all patents, patent
applications, trademarks, service marks, copyrights, trade secrets, processes,
formulations, technology or know-how currently used in the conduct of its
business (the “Proprietary
Rights”).
The
Company has not received any notice of any claims, nor does it have any
knowledge of any threatened claims, and knows of no facts which would form
the
basis of any claim, asserted by any person to the effect that the sale or
use of
any product or process now used or offered by the Company or proposed to
be used
or offered by the Company infringes on any patents or infringes upon the
use of
any such Proprietary Rights of another person and, to the best of the Company’s
or knowledge, no others have infringed the Company’s Proprietary
Rights.
(i) Litigation.
There
is no material action, suit, investigation, customer complaint, claim or
proceeding at law or in equity by or before any arbitrator, court, governmental
instrumentality or agency, self-regulatory organization or body or public
board
now pending or, to the knowledge of the Company, threatened against the Company
of any of the officers or directors of the Company in their capacities as
such
(or basis therefor known to the Company), the adverse outcome of which would
have a Material Adverse Effect. To its knowledge, the Company is not subject
to
any judgment, order, writ, injunction or decree of any Federal, state, municipal
or other governmental department, commission, board, bureau, agency or
instrumentality, domestic or foreign which have a Material Adverse
Effect.
(j) Non-Defaults;
Non-Contravention.
The
Company is not in violation of or default under, nor will the execution and
delivery of this Agreement or any of the Transaction Documents or consummation
of the transactions contemplated herein or therein result in a violation
of or
constitute a default in the performance or observance of any obligation under:
(i)
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its
Articles of Incorporation, or its By-laws; or (ii) any indenture, mortgage,
contract, material purchase order or other agreement or instrument to which
the
Company is a party or by which it or its property is bound, where such violation
or default would have a Material Adverse Effect; or (iii) any material order,
writ, injunction or decree of any court of any Federal, state, municipal
or
other governmental department, commission, board, bureau, agency or
instrumentality, domestic or foreign, where such violation or default would
have
a Material Adverse Effect, and to the Company’s knowledge, there exists no
condition, event or act which constitutes, nor which after notice, the lapse
of
time or both, could constitute a default under any of the foregoing, which
in
either case would have a Material Adverse Effect.
(k) Taxes.
The
Company has filed all Federal, state, local and foreign tax returns which
are
required to be filed by it or otherwise met its disclosure obligations to
the
relevant agencies and all such returns are true and correct in all material
respects. The Company has paid or adequately provided for all tax liabilities
of
the Company as reflected on such returns or pursuant to any assessments received
by it or which it is obligated to withhold from amounts owing to any employee,
creditor or third party. The tax returns of the Company have never been audited
by any state, local or Federal authorities. The Company has not waived any
statute of limitations with respect to taxes or agreed to any extension of
time
with respect to any tax assessment or deficiency.
(l) Compliance
With Laws; Licenses, Etc.
The
Company has not received notice of any violation of or noncompliance with
any
Federal, state, local or foreign, laws, ordinances, regulations and orders
applicable to its business which has not been cured, the violation of, or
noncompliance with which, would have a Material Adverse Effect. To its
knowledge, the Company has all material licenses and permits and other
governmental certificates, authorizations and permits and approvals
(collectively, “Licenses”)
required by every Federal, state and local government or regulatory body
for the
operation of its business as currently conducted and the use of its properties,
except where the failure to be licensed or possess a permit would not have
a
Material Adverse Effect. The Licenses are in full force and effect and to
the
Company’s knowledge no violations currently exist in respect of any License and
no proceeding is pending or threatened to revoke or limit any
thereof.
(m) Authorization
of Agreement, Etc.
The
Company has the requisite corporate power and authority to enter into and
perform its obligations under this Agreement and the other Transaction
Documents. The execution and delivery of the Transaction Documents by the
Company and the consummation by the Company of the transactions contemplated
by
the Transaction Documents, including without limitation the issuance of the
Securities, have been duly authorized by the Company’s Board of Directors (the
“Board”)
and no
further consent or authorization is required by the Company, the Board or
the
Company’s stockholders. The Transaction Documents, when executed, will have been
duly executed and delivered by the Company, and will constitute valid and
binding obligations of the Company enforceable against the Company in accordance
with their terms, except as such enforceability may be limited by general
principles of equity or applicable bankruptcy, insolvency, reorganization,
moratorium, liquidation or similar laws relating to, or affecting generally,
the
enforcement of creditors’ rights and remedies.
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(n) Authorization
of the Securities.
The
issuance, sale and delivery of the Debentures, the Subscriber Warrants and
the
Agent’s Warrants and the Agent’s Shares shall have been duly authorized by all
requisite corporate action of the Company. When so issued, sold and delivered
in
accordance with the Transaction Documents for the consideration set forth
therein, the Debentures, the Subscriber Warrants and the Agent’s Warrants and
the Agent’s Shares will be duly executed, issued and delivered and will
constitute valid and legal obligations of the Company enforceable in accordance
with their respective terms, except as such enforceability may be limited
by
general principles of equity or applicable bankruptcy, insolvency,
reorganization, moratorium, liquidation or similar laws relating to, or
affecting generally, the enforcement of creditors’ rights and remedies and, in
each case, will not be subject to preemptive or any other similar rights
of the
stockholders of the Company or others which rights except as set forth herein
or
which shall not have been waived prior to the closing of the
Placement.
(o) Authorization
of Underlying Shares.
The
issuance, sale and delivery by the Company of the Underlying Shares have
been
duly authorized by all requisite corporate action of the Company, and the
Underlying Shares have been duly reserved for issuance upon conversion or
exercise, as the case may be, of all or any of the Debentures, Subscriber
Warrants or Agent’s Warrants, and when so issued, sold, paid for and delivered
for the consideration set forth in the Transaction Documents, the Underlying
Shares will be validly issued and outstanding, fully paid and non-assessable,
and except as set forth herein, shall not subject to preemptive or any other
similar rights of the stockholders of the Company or others which rights
shall
not have been waived prior to the closing of the Placement.
(p) Exemption
from Registration.
Assuming (i) the accuracy of the information provided by the respective
Subscribers in the Offering Documents and (ii) that the Placement Agent has
complied in all material respects with this Agreement and the provisions
of
Regulation D promulgated under the 1933 Act, the offer and sale of the
Securities in the Placement pursuant to the terms of this Agreement will
be
exempt from the registration requirements of the 1933 Act and the rules and
regulations promulgated thereunder. The Company is not disqualified from
the
exemption under Regulation D by virtue of any disqualifications contained
in
Rule 505(b)(2)(iii) or Rule 507 promulgated thereunder expressly applicable
to
the Company.
(q) Brokers.
Neither
the Company nor any of its officers, directors, employees or stockholders
has
employed any broker or finder in connection with the transactions contemplated
by this Agreement other than the Placement Agent and Selected
Dealers.
(r) Title
to Securities.
When
certificates representing the Debentures, the Subscriber Warrants and the
Agent’s Warrants and the Agent’s Shares have been duly delivered to the
Subscribers, or to the Placement Agent, as the case may be, and payment shall
have been made therefor, the Subscribers shall receive good and marketable
title
to such securities free and clear of all liens, encumbrances and claims
whatsoever (with the exception of claims arising through the acts or omissions
of the Subscribers and except as arising from applicable Federal and state
securities laws), and the Company shall have paid all transfer taxes, if
any, in
respect of the original issuance thereof.
(s) Consents.
Except
as contemplated by this Agreement or as required under Regulation D and
applicable Blue Sky laws, the Company is not required to obtain any consent,
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authorization
or order of, or make any filing or registration with, any court or governmental
agency or any regulatory or self-regulatory agency in order for it to execute,
deliver or perform any of its obligations under or contemplated by the
Transaction Documents. Except as otherwise provided in the Transaction
Documents, all consents, authorizations, orders, filings and registrations
which
the Company is required to obtain pursuant to the preceding sentence have
been
obtained or effected, or will be obtained and effected, on or prior to the
closing of the Placement. The Company is not aware of any facts or circumstances
that might prevent the Company from obtaining or effecting any of the
foregoing.
(t) No
General Solicitation.
None of
the Company, any of its affiliates, and any person acting on its behalf,
has
engaged in any form of general solicitation or general advertising (within
the
meaning of Regulation D under the 0000 Xxx) in connection with the offer
or sale
of the Securities.
(u) No
Integrated Offering.
None of
the Company, any of its affiliates, and any person acting on its behalf has,
directly or indirectly, made any offers or sales of any security or solicited
any offers to buy any security, under circumstances that would require
registration of any of the Securities under the 1933 Act or cause the Placement
to be integrated with prior offerings by the Company for purposes of the
1933
Act or any applicable stockholder approval provisions, including without
limitation, under the rules and regulations of any exchange or automated
quotation system on which any of the securities of the Company is listed
or
designated. None of the Company, its affiliates and any person acting on
its
behalf will take any action or steps referred to in the preceding sentence
that
would require registration of any of the Securities under the 1933 Act or
cause
the Placement to be integrated with other offerings.
(v) Application
of Takeover Protections; Rights Agreement.
The
Company and the Board have taken all necessary action, if any, in order to
render inapplicable any control share acquisition, business combination,
poison
pill (including any distribution under a rights agreement) or other similar
anti-takeover provision under the Certificate of Incorporation of the Company,
or the laws of the state of its incorporation which is or could become
applicable as a result of the transactions contemplated by this Agreement.
The
Company has not adopted a shareholder rights plan or similar arrangement
relating to accumulations of beneficial ownership of Common Stock or a change
in
control of the Company.
(w) Right
of First
Refusal.
Except
for the right of first refusal previously granted to the Placement Agent
herein,
no person, firm or other business entity is a party to any agreement, contract
or understanding, written or oral entitling such party to a right of first
refusal with respect to offerings by the Company.
(x) Foreign
Corrupt Practices.
Neither
the Company, nor any director, officer, agent, employee or other person acting
on behalf of the Company has, in the course of its actions for, or on behalf
of,
the Company, (i) used any corporate funds for any unlawful contribution,
gift,
entertainment or other unlawful expenses relating to political activity;
made
any direct or indirect unlawful payment to any foreign or domestic government
official or employee from corporate funds, (ii) violated or is in violation
of
any provision of the U.S. Foreign Corrupt Practices Act of 1977, as amended,
or
(iii) made any unlawful bribe, rebate, payoff, influence payment, kickback
or
other unlawful payment to any foreign or domestic government official or
employee.
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3. Closing;
Placement and Fees.
(a) Closing
of the Placement.
A
closing (the “Initial
Closing”)
shall
take place at the New York offices of Gottbetter & Partners, LLP, counsel
for the Placement Agent, within three business days after gross proceeds
of
$1,000,000, from the sale Debentures have been received by the Placement
Agent
and delivered to the escrow agent pursuant to the Fund Escrow Agreement (but
in
no event later than five days following the PPO Termination Date), which
closing
date may be accelerated or adjourned by agreement between the Company and
the
Placement Agent. At the Initial Closing, payment for the Debentures issued
and
sold by the Company shall be made against delivery of the certificates for
the
Debentures sold. In addition, subsequent closings of the PPO (if applicable)
may
be scheduled at the discretion of the Company and Placement Agent, each of
which
shall be referred to herein as a “Closing.”
(b) Conditions
to Placement Agent’s Obligations.
The
obligations of the Placement Agent hereunder will be subject to the accuracy
of
the representations and warranties of the Company herein contained as of
the
date hereof and as of each closing date of the Placement, to the performance
by
the Company of its obligations hereunder and to the following additional
conditions:
(i) Due
Qualification or Exemption.
(A) The
Placement will become qualified or be exempt from qualification under the
securities or “blue sky” laws of the several states pursuant to Section 4(d)
below not later than the closing date of the Initial Closing, and (B) at
each
Closing no stop order suspending the sale of the Debentures shall have been
issued, and no proceedings by an governmental agency, self-regulatory
organization or any securities exchange for that purpose shall have been
initiated or threatened.
(ii) No
Material Misstatements.
Neither
the blue sky qualification materials nor the Offering Documents, nor any
supplement thereto, will contain any untrue statement of a fact which in
the
opinion of the Placement Agent is material, or omit to state a fact, which
in
the opinion of the Placement Agent is material and is required to be stated
therein, or is necessary to make the statements therein, in light of the
circumstances under which they were made, not misleading.
(iii) Compliance
with Agreements.
The
Company will have complied with all agreements and satisfied all conditions
on
its part to be performed or satisfied hereunder at or prior to each
Closing.
(iv) Corporate
Action.
The
Company will have taken all necessary corporate action, including, without
limitation, obtaining the approval of the Board, and, if necessary, its
stockholders, for the execution and delivery of this Agreement, the performance
by the Company of its obligations hereunder and the Placement contemplated
hereby.
(v) Opinion
of Counsel.
The
Placement Agent shall receive the (i) opinion of Xxxxxx & Xxxxxxxxx LLP,
counsel to the Company, addressed to the Placement Agent and the Subscribers,
in
form and substance reasonably acceptable to the Placement
Agent.
9
(vi) Officers’
Certificate.
The
Placement Agent shall receive a certificate of the Company, signed by the
Chief
Executive Officer and Chief Financial Officer thereof, that the representations
and warranties contained in Section 2 hereof are true and accurate in all
material respects as of the date hereof and at such Closing with the same
effect
as though expressly made at such Closing.
(vii) Stockholder
Consents.
The
Placement Agent shall have received copies of such duly executed waivers
and
consents from the holders of the Company’s outstanding securities as counsel to
the Placement Agent deems necessary or important for completion of the
Placement.
(viii) Due
Diligence.
The
Placement Agent shall have completed and been satisfied with the results
of its
due diligence investigation of the Company, including, without limitation,
the
Company’s financial statements, projections, expense budgets, business
prospects, capital structure, background searches and contractual
arrangements.
The
obligation of the Placement Agent to consummate the PPO is subject to the
following additional condition:
(ix) Fund
Escrow Agreement.
The
Placement Agent shall receive a copy of a duly executed escrow agreement
in the
form previously delivered to the Placement Agent regarding the deposit of
funds
pending the Closing(s) of the PPO with a bank or trust company acceptable
to the
Placement Agent (the “Fund
Escrow Agreement”).
(c) Blue
Sky.
The
Company will prepare and file the necessary documents so that offers and
sales
of the securities to be offered in the Placement may be made in certain
jurisdictions in the United States.
(d) Placement
Fee and Expenses.
(i) PPO.
Simultaneously with payment for and delivery of the Debentures at each Closing,
the Company shall: (A) pay to the Placement Agent a placement fee equal to
10%
of the aggregate purchase price of the Debentures sold; and (B) issue to
the
Placement Agent or its designees, consistent with meeting the requirements
of an
exemption from registration under the 1933 Act (i) ten-year warrants in the
form
attached hereto as Appendix A to purchase that number of shares of Common
Stock
of the Company is equal to 15,457.48 warrants per $10,000 of gross proceeds
from
the sale of the Debentures (the “Agent’s
Warrants”),
up to
a maximum of 6,182,992 Agent’s Warrants and (ii) 50,000 shares of Common Stock
of the Company (the “Agent’s Shares”). The Company shall, upon demand, reimburse
the Placement Agent for its accountable expenses incurred in connection with
the
PPO and pay all expenses in connection with the qualification of the Underlying
Shares under the securities or Blue Sky laws of the states which the Placement
Agent shall designate, including legal fees and filing fees. It is anticipated
that the Placement Agent’s reimbursable expenses in connection with the
Placement will not exceed $180,000. The Placement Agent will promptly notify
the
Company in the event its accountable expenses will materially exceed $180,000
and the Placement Agent and Company shall mutually agree to any such greater
amount.
10
(ii) Interest.
In the
event that for any reason the Company shall fail to pay to the Placement
Agent
all or any portion of the fees payable hereunder when due, interest shall
accrue
and be payable on the unpaid cash balance due hereunder from the date when
first
due through and including the date when actually collected by the Placement
Agent, at a rate equal to four percent above the prime rate of Citibank,
N.A.,
in New York, New York, computed on a daily basis and adjusted as announced
from
time to time.
(e) Bring-Down
Opinions and Certificates.
If
there is more than one Closing, then at the request of the Placement Agent,
at
each such Closing there shall be delivered to the Placement Agent an updated
opinion and certificate as described in (v) and (vi) of Section 3(b) above,
respectively.
(f) No
Adverse Changes.
There
shall not have occurred, at any time prior to the applicable Closing (i)
any
domestic or international event, act or occurrence which has materially
disrupted, or in the Placement Agent’s opinion will in the immediate future
materially disrupt, the securities markets; (ii) a general suspension of,
or a
general limitation on prices for, trading in securities on the New York Stock
Exchange or other national market or exchange or in the over-the-counter
market;
(iii) any outbreak of major hostilities or other national or international
calamity; (iv) any banking moratorium declared by a state or federal authority;
(v) any moratorium declared in foreign exchange trading by major international
banks or other persons; (vi) any material interruption in the mail service
or
other means of communication within the United States; (vii) any material
adverse change in the business, properties, assets, results of operations,
or
financial condition of the Company; or (viii) any change in the market for
securities in general or in political, financial, or economic conditions
which,
in the Placement Agent’s judgment, makes it inadvisable to proceed with the
Placement.
4. Covenants
of the Company.
(a) Use
of
Proceeds.
The net
proceeds of the PPO will be used by the Company substantially as set forth
in
the Memorandum. The Company shall not use any of the proceeds from the Placement
to repay any indebtedness of the Company (other than trade payables in the
ordinary course), including but not limited to indebtedness to any current
executive officers, directors or principal stockholders of the Company, or
any
subsidiary thereof.
(b) Expenses
of Offering.
The
Company shall be responsible for, and shall bear all expenses directly incurred
in connection with, the proposed Placement including, but not limited to,
(i)
legal fees of the Company’s counsel relating to the costs of preparing the
Offering Documents and all amendments, supplements and exhibits thereto and
preparing and delivering all Placement Agent and selling documents, Debenture
and Warrant certificates; and (ii) blue sky fees, filing fees and the fees
and
disbursements of Placement Agent’s counsel in connection with blue sky matters
(the “Company
Expenses”).
In
addition, the Company shall reimburse the Placement Agent for all of its
reasonable out-of-pocket expenses incurred in connection with the Placement,
including, without limitation the Placement Agent’s mailing, printing, copying,
telephone, travel, background searches, due diligence investigations, legal
and
consulting fees or other similar expenses (the “Placement
Agent Expenses”),
subject to Section 3(d).
11
If
the
Company decides not to proceed with the Placement for any reason (other than
the
material breach of the Placement Agent’s representations, warranties or
covenants in Section 5 of this Agreement) or if the Placement Agent decides
not
to proceed with the Placement because of a material breach by the Company
of its
representations, warranties, or covenants in this Agreement or as a result
of
material adverse changes in the affairs of the Company, the Company will
be
obligated to pay the Placement Agent liquidated damages of $150,000 in cash
(the
method of payment to be at the sole discretion of the Placement Agent) and
to
reimburse the Placement Agent for the Placement Agent expenses as set forth
above. The Placement Agent shall have no liability to the Company for any
reason
should the Placement Agent choose not to proceed with the Placement contemplated
hereby.
(c) Notification.
The
Company shall notify the Placement Agent immediately, and in writing, (i)
when
any event shall have occurred during the period commencing on the date hereof
and ending on the later of the last Closing or the Termination Date as a
result
of which the Offering Documents would include any untrue statement of a material
fact or omit to state any material fact required to be stated therein or
necessary to make the statements therein not misleading, and (ii) of the
receipt
of any notification with respect to the modification, rescission, withdrawal
or
suspension of the qualification or registration of the Securities, or of
any
exemption from such registration or qualification, in any jurisdiction. The
Company will use its best efforts to prevent the issuance of any such
modification, rescission, withdrawal or suspension and, if any such
modification, rescission, withdrawal or suspension is issued and the Placement
Agent so request, to obtain the lifting thereof as promptly as
possible.
(d) Blue
Sky.
The
Company will use its best efforts to qualify or register the securities to
be
offered in the Placement for offering and sale under, or establish an exemption
from such qualification or registration under, the securities or “blue sky” laws
of such jurisdictions as the Placement Agent may reasonably request; provided
however, that the Company will not be obligated to qualify as a dealer in
securities in any jurisdiction in which it is not so qualified or consent
to the
general service of process in any such jurisdiction. The Company will not
consummate any sale of securities pursuant to the Placement in any jurisdiction
in which it is not so qualified or in any manner in which such sale may not
be
lawfully made.
(e) Form
D
Filing.
The
Company shall file five copies of a Notice of Sales of Securities on Form
D with
the SEC no later than 15 days after the first sale of the Debentures. The
Company shall file promptly such amendments to such Notices on Form D as
shall
become necessary and shall also comply with any filing requirement imposed
by
the laws of any state or jurisdiction in which offers and sales are made.
The
Company shall furnish the Placement Agent with copies of all such
filings.
(f) Press
Releases, Etc.
The
Company shall not, during the period commencing on the date hereof and ending
on
the PPO Termination Date, issue any press release or other communication,
or
hold any press conference with respect to the Company, or its financial
condition, results of operations, business, properties, assets, or liabilities,
or the Placement, without the prior consent of the Placement Agent, which
consent shall not be unreasonably withheld. The Company shall not include
information with respect to the Placement or use the Placement Agent’s name in
any press release, advertisement or on any website maintained by the
12
Company
with out the prior written consent of the Placement Agent, such consent not
to
be unreasonably withheld.
(g) Executive
Compensation.
The
compensation of the Company’s executive officers shall not increase during the
three-year period following the Closing without the approval of a majority
of
the independent members of the Board.
(h) Restrictions
on Issuances of Securities.
During
the period commencing on the date hereof and ending on the later of (i) the
final Closing or (ii) the Termination Date, the Company will not, without
the
prior written consent of the Placement Agent, issue additional shares of
Common
Stock, other than pursuant to the exercise of options or warrants outstanding
on
the date hereof, or grant any warrants, options or other securities of the
Company.
5. Representations,
Warranties and Covenants of the Placement Agent.
(a) No
General Solicitation.
No form
of general solicitation or general advertising has been or will be used by
the
Placement Agent or any of its affiliates or representatives in connection
with
the offer and sale of any of the Debentures, including, but not limited to,
articles, notices or other communication published in any newspaper, magazine
or
similar medium or broadcast over television or radio, or any seminar or meeting
whose attendees have been invited by general solicitation or general
advertising.
(b) Delivery
of Memorandum.
Prior
to or simultaneously with the sale by the Company to any purchaser of any
of the
Debentures pursuant hereto, the Placement Agent will furnish to such purchaser
a
copy of the Memorandum (and any amendment thereof or supplement thereto that
the
Company shall have furnished to the Placement Agent prior to the date of
such
sale).
(c) Registration;
Good Standing.
The
Placement Agent represents and warrants to the Company that it is: (1) a
broker-dealer registered with the SEC pursuant to the Securities and Exchange
Act of 1934, as amended (the “1934
Act”);
(2) a
member in good standing of the National Association of Securities Dealers,
Inc.;
and (3) registered and qualified to act in each state and jurisdiction in
which
it is required to be registered as such in order to offer and sell the
Debentures.
(d) Authorization.
The
Placement Agent represents and warrants to the Company that the person who
has
signed this Agreement on its behalf is duly authorized to so sign, and this
Agreement is a valid and binding obligation of the Placement Agent, enforceable
in accordance with its terms, subject, as to enforcement of remedies, to
applicable bankruptcy, insolvency, reorganization, moratorium and other laws
affecting the rights of creditors generally and the discretion of courts
in
granting equitable remedies and except that enforceability of the
indemnification and contribution provisions set forth thereunder and hereunder
may be limited by the federal securities laws of the United States or state
securities laws or public policies related thereto.
(e) Compliance
with Regulation D.
Neither
the Placement Agent nor any of its affiliates nor any person acting on behalf
of, or as agent for, the forgoing, shall take any action in
13
connection
with any offering hereunder which would cause such offering not to comply
with
Rule 506 of Regulation D.
(f) Accredited
Investors.
The
Placement Agent shall not offer the Debentures to any prospective Subscriber
(i)
if the Placement Agent has reason to believe that material information supplied
or the representations and warranties made by that person are not fully
accurate; or (ii) unless immediately prior to making such offer, the Placement
Agent reasonably believes that such person is an “accredited investor” as
defined in Rule 501 promulgated under the 1933 Act.
(g)
Investment
Intent/Accredited Investor.
The
Placement Agent represents and warrants to the Company that it is an “accredited
investor” as defined in Rule 501 promulgated under the 1933 Act and that it is
receiving the Agent’s Shares and the Agent’s Warrants for investment purposes
and not with a present view toward resale or distribution.
6. Indemnification.
(a) The
Company agrees to indemnify and hold harmless the Placement Agent and each
Selected Dealer, if any, and their respective shareholders, directors, officers,
agents and controlling persons (an “Agent
Indemnified Party”)
against any and all loss, liability, claim, damage and expense whatsoever
(and
all actions in respect thereof), and to reimburse the Placement Agent for
reasonable legal fees and related expenses as incurred (including, but not
limited to the costs of investigating, preparing or defending any such action
or
claim whether or not in connection with litigation in which the Placement
Agent
is a party and the costs of giving testimony or furnishing documents in response
to a subpoena or otherwise), caused by or arising out of (i) any untrue
statement or alleged untrue statement of a material fact contained in the
Transaction Documents or the omission or alleged omission therefrom of a
material fact necessary in order to make the statements therein, in light
of the
circumstances under which they were made, not misleading (provided, however,
that the Company shall not be liable in any such case to the extent that
any
such loss, liability, claim, damage or expense arises out of or is based
upon
any untrue statement of a material fact or alleged untrue statement or a
material fact provided by the Placement Agent in writing to the Company),
(ii)
any violation by the Company of the federal securities laws or the securities
laws of any states, or otherwise arising out of the Placement Agent’s engagement
hereunder, except in respect of any matters as to which the Placement Agent
shall have been adjudicated to have acted with gross negligence, or (iii)
any
breach by the Company of any of its representations, warranties or covenants
contained in this Agreement;
provided,
however,
that in
the case of each of clauses (ii) and (iii) hereof, there has been a final
adjudication of such violation or breach by a court of competent
jurisdiction.
(b) The
Placement Agent agrees to indemnify and hold harmless the Company and its
shareholders, directors, officers, agents and controlling persons (a
“Company
Indemnified Party”
and,
together with an Agent Indemnified Party, an “Indemnified
Party”)
against any and all loss, liability, claim, damage and expense whatsoever
(and
all actions in respect thereof), and to reimburse the Company for reasonable
legal fees and related expenses as incurred (including, but not limited to
the
costs of investigating, preparing or defending any such action or claim whether
or not in connection with litigation in which the Company is a party and
the
costs of giving testimony or furnishing documents in response to a subpoena
or
otherwise), caused by or arising out of (i) any breach by the Placement Agent
of
any of its representations, warranties and
14
covenants
contained in this Agreement, or (ii) any violation by the Placement Agent
of the
federal securities laws or the securities laws of any state, or otherwise
arising out of the Placement Agent’s engagement hereunder, except in respect of
any matters as to which the Company shall have been adjudicated to have acted
with gross negligence; provided,
however,
that in
the case of each of clauses (i) and (ii) hereof, there has been a final
adjudication of such breach or violation by a court of competent jurisdiction;
and provided,
however,
that
the aggregate liability of the Placement Agent under this Section 6 shall
not
exceed an amount equal to the aggregate placement fees received by the Placement
Agent pursuant to Section 3(d)(i) or Section 3(d)(ii) hereof.
(c) Promptly
after receipt by an Indemnified Party under this Section of notice of the
commencement of any action, the Indemnified Party will, if a claim in respect
thereof is to be made against the party from whom indemnification is sought
under this Section 6 (the “Indemnifying
Party”),
notify in writing the Indemnifying Party of the commencement thereof; but
the
omission so to notify the Indemnifying Party will not relieve the Indemnifying
Party from any liability which it may have to the Indemnified Party otherwise
under this Section except to the extent the defense of the claim is prejudiced.
In case any such action is brought against an Indemnified Party, and it notifies
the Indemnifying Party of the commencement thereof, the Indemnifying Party
will
be entitled to participate in, and, to the extent that it may wish, jointly
with
any other indemnifying party similarly notified, to assume the defense thereof,
subject to the provisions herein stated, with counsel reasonably satisfactory
to
the Indemnified Party, and after notice from the Indemnifying Party to the
Indemnified Party of its election so to assume the defense thereof, the
Indemnifying Party will not be liable to the Indemnified Party under this
Section for any legal or other expenses subsequently incurred by the Indemnified
Party in connection with the defense thereof other than reasonable costs
of
investigation (provided the Indemnifying Party has been advised in writing
that
such investigation is being undertaken). The Indemnified Party shall have
the
right to employ separate counsel in any such action and to participate in
the
defense thereof, but the fees and expenses of such counsel shall not be at
the
expense of the Indemnifying Party if the Indemnifying Party has assumed the
defense of the action with counsel reasonably satisfactory to the Indemnified
Party; provided that the reasonable fees and expenses of such counsel shall
be
at the expense of the Indemnifying Party if (i) the employment of such counsel
has been specifically authorized in writing by the Indemnifying Party or
(ii)
the named parties to any such action (including any impleaded parties) include
both the Indemnified Party or Parties and the Indemnifying Party and, in
the
reasonable judgment of counsel for the Indemnified Party, it is advisable
for
the Indemnified Party or Parties to be represented by separate counsel due
to an
actual conflict of interest (in which case the Indemnifying Party shall not
have
the right to assume the defense of such action on behalf of an Indemnified
Party
or Parties), it being understood, however, that the Indemnifying Party shall
not, in connection with any one such action or separate but substantially
similar or related actions in the same jurisdiction arising out of the same
general allegations or circumstances, be liable for the reasonable fees and
expenses of more than one separate firm of attorneys for all the Indemnified
Parties. No settlement of any action against an Indemnified Party shall be
made
unless such an Indemnified Party is fully and completely released in connection
therewith.
15
7. Contribution.
To
provide for just and equitable contribution, if an Indemnified Party makes
a
claim for indemnification pursuant to Section 6 but it is found in a final
judicial determination, not subject to further appeal, that such indemnification
may not be enforced in such case, even though this Agreement expressly provides
for indemnification in such case, then the Company (including for this purpose
any contribution made by or on behalf of any officer, director, employee
or
agent for the Company, or any controlling person of the Company), on the
one
hand, and the Placement Agent and any Selected Dealers (including for this
purpose any contribution by or on behalf of an Indemnified Party), on the
other
hand, shall contribute to the losses, liabilities, claims, damages, and expenses
whatsoever to which any of them may be subject, in such proportions as are
appropriate to reflect the relative benefits received by the Company, on
the one
hand, and the Placement Agent and the Selected Dealers, on the other hand;
provided, however, that if applicable law does not permit such allocation,
then
other relevant equitable considerations such as the relative fault of the
Company and the Placement Agent and the Selected Dealers in connection with
the
facts which resulted in such losses, liabilities, claims, damages, and expenses
shall also be considered. In no case shall the Placement Agent or a Selected
Dealer be responsible for a portion of the contribution obligation in excess
of
the compensation received by it or the Selected Dealers, as the case may
be. No
person guilty of a fraudulent misrepresentation shall be entitled to
contribution from any person who is not guilty of such fraudulent
misrepresentation. For purposes of this Section 7, each person, if any, who
controls the Placement Agent or a Selected Dealer within the meaning of Section
15 of the 1933 Act or Section 20(a) of the 1934 Act and each officer, director,
stockholder, employee and agent of the Placement Agent or a Selected Dealer,
shall have the same rights to contribution as the Placement Agent or the
Selected Dealer, and each person, if any, who controls the Company within
the
meaning of Section 15 of the 1933 Act or Section 20(a) of the 1934 Act and
each
officer, director, employee and agent of the Company, shall have the same
rights
to contribution as the Company, subject in each case to the provisions of
this
Section 7. Anything in this Section 7 to the contrary notwithstanding, no
party
shall be liable for contribution with respect to the settlement of any claim
or
action effected without its written consent. This Section 7 is intended to
supersede any right to contribution under the 1933 Act, the 1934 Act, or
otherwise.
8. Miscellaneous.
(a) Survival.
Any
termination of any offering hereunder without consummation thereof shall
be
without obligation on the part of any party except that the indemnification
provided in Section 6 hereof and the contribution provided in Section 7 hereof
shall survive any termination and shall survive the final Closing for a period
of two years.
(b) Representations,
Warranties and Covenants to Survive Delivery.
The
respective representations, warranties, indemnities, agreements, covenants
and
other statements as of the date hereof and as of the date of each Closing
shall
survive execution of this Agreement and delivery of the Debentures and the
termination of this Agreement for a period of one year after such respective
event.
16
(c) No
Other Beneficiaries.
This
Agreement is intended for the sole and exclusive benefit of the parties hereto
and their respective successors and controlling persons, and no other person,
firm or corporation shall have any third-party beneficiary or other rights
hereunder.
(d) Governing
Law; Resolution of Disputes.
This
Agreement shall be governed by and construed in accordance with the law of
the
State of New York without regard to conflict of law provisions. The Placement
Agent and the Company will attempt to settle any claim or controversy arising
out of this Agreement through consultation and negotiation in good faith
and a
spirit of mutual cooperation. Should such attempts fail, then the dispute
will
be mediated by a mutually acceptable mediator to be chosen by the Placement
Agent and the Company within 15 days after written notice from either party
demanding mediation. Neither party may unreasonably withhold consent to the
selection of a mediator, and the parties will share the costs of the mediation
equally. Any dispute which the parties cannot resolve through negotiation
or
mediation within six months of the date of the initial demand for it by one
of
the parties may then be submitted to the courts for resolution. The use of
mediation will not be construed under the doctrine of latches, waiver or
estoppel to affect adversely the rights of either party. Nothing in this
paragraph will prevent either party from resorting to judicial proceedings
if
(a) good faith efforts to resolve the dispute under these procedures have
been
unsuccessful or (b) interim relief from a court is necessary to prevent serious
and irreparable injury.
(e) Counterparts.
This
Agreement may be signed in counterparts with the same effect as if both parties
had signed one and the same instrument.
(f) Notices.
Any
communications specifically required hereunder to be in writing, if sent
to the
Placement Agent, will be sent by overnight courier providing a receipt of
delivery or by certified or registered mail to it at Strasbourger Xxxxxxx
Tulcin
Xxxxx Incorporated, 00 Xxxxxxxxx Xxxxxx, 00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000, Att: Xxx Xxxxxxxxx, with a copy to Gottbetter
& Partners, 000 Xxxxxxx Xxx., 00xx
Xxxxx,
Xxx Xxxx, XX00000, Att: Xxxxxxx X. Xxxxxxx and if sent to the Company, will
be
sent by overnight courier providing a receipt of delivery or by certified
or
registered mail to it at 0000 X. Xxxxxx Xxxxxx, Xxxxx Xxxx, Xxxxxxx 00000,
Att:
Xxxx Xxxxxxx, with a copy to BT Law, 600 1st
Source
Bank Building, 000 X. Xxxxxxxx, Xxxxx Xxxx Xxxxxxx 00000, Att: Xxxxxxx X.
Xxxxx.
(g) Entire
Agreement.
This
Agreement constitutes the entire agreement of the parties with respect to
the
matters herein referred and supersedes all prior agreements and understandings,
written and oral, between the parties with respect to the subject matter
hereof.
Neither this Agreement nor any term hereof may be changed, waived or terminated
orally, except by an instrument in writing signed by the party against which
enforcement of the change, waiver or termination is sought.
17
If
the
Placement Agent finds the foregoing is in accordance with its understanding
with
the Company, kindly sign and return to the Company a counterpart hereof,
whereupon this instrument along with all counterparts will become a binding
agreement between the Placement Agent the Company.
Very
truly yours,
|
||||||
MAGNETECH
INTEGRATED SERVICES CORP.
|
||||||
By:
|
/s/ Xxxx X. Xxxxxxx | |||||
Name:
Xxxx X. Xxxxxxx
|
||||||
Title:
President & CEO
|
Agreed:
STRASBOURGER
XXXXXXX TULCIN XXXXX INCORPORATED
By:
|
/s/ Xxxxxxx X. Xxxxxxxxxx
|
|
Name:
Xxxxxxx X. Xxxxxxxxxx
|
||
Title:
President
|
18
Exhibit
A
IMPORTANT:
|
Investor
Name: ____________________
|
Please
Complete
|
INDIVIDUAL
INVESTOR QUESTIONNAIRE
_________________________
MAGNETECH
INTEGRATED SERVICES CORP
__________________________
Magnetech
Integrated Services Corp
0000
Xxxxx Xxxxxx Xxxxxx
Xxxxx
Xxxx, Xxxxxxx 00000
The
information contained in this Questionnaire is being furnished in order
to
determine whether the undersigned’s subscription to purchase Debentures and
Warrants(the “Securities”) of Magnetech Integrated Services Corp. (the
“Company”) may be accepted.
One
(1)
copy of this Questionnaire should be completed, signed, dated and delivered
to
Xxxxxx Xxxx at Xxxxxxxxxxxx Xxxxxxx Tulcin Xxxxx Inc. 00 Xxxxxxxxx Xxxxxx,
00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000. Please contact Xxxxxx Xxxx at 000-000-0000 if
you have
any questions with respect to this Questionnaire.
ALL
INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY.
The
undersigned understands, however, that the Company may present this
Questionnaire to such parties as it deems appropriate if called upon to
establish that the proposed offer and sale of the is exempt from
registration under the Securities Act of 1933, as amended, or meets the
requirements of applicable state securities or “blue sky” laws. Further, the
undersigned understands that the offering is required to be reported to
the
Securities and Exchange Commission and to various state securities or “blue sky”
regulators.
IF
YOU ARE PURCHASING SECURITIES WITH YOUR SPOUSE, YOU MUST
BOTH SIGN
THE SIGNATURE PAGE (PAGE A_5).
|
IF
YOU ARE PURCHASING SECURITIES WITH ANOTHER PERSON NOT
YOUR SPOUSE,
YOU MUST EACH FILL OUT A SEPARATE QUESTIONNAIRE.
Please make a photocopy of pages A_1 to A_5 and return both completed
Questionnaires to the Placement Agent in the same
envelope.
|
I.
|
PLEASE
INDICATE DESIRED TYPE OF OWNERSHIP OF
SECURITIES:
|
[ ] Individual
[ ] Joint
Tenants (rights of survivorship)
[ ] Tenants
in Common (no rights of survivorship)
A-1
II.
|
PLEASE
CHECK ANY OF STATEMENTS 1-4 BELOW THAT APPLY TO
YOU.
|
[ ]
|
1.
|
I
have an individual net worth*
or
joint net worth with my spouse in excess of $1,000,000.
|
[ ]
|
2.
|
I
have had an individual income*
in
excess of $200,000 in each of the previous two years and I reasonably
expect an individual income in excess of $200,000 for this year.
NOTE: IF
YOU ARE BUYING JOINTLY WITH YOUR SPOUSE, YOU MUST EACH HAVE AN
INDIVIDUAL
INCOME IN EXCESS OF $200,000 IN EACH OF THESE YEARS IN ORDER
TO CHECK THIS
BOX.
|
[ ]
|
3.
|
My
spouse and I have had a joint income*
in
excess of $300,000 in each of the previous two years and I reasonably
expect a joint income in excess of $300,000 for this
year.
|
[ ]
|
4.
|
I
am a director and/or an executive officer of the Company as such
terms are
defined in Regulation D promulgated under the Securities Act
of 1933, as
amended.
|
III.
|
OTHER
CERTIFICATIONS
|
By
signing the Signature Page, I certify the following (or, if I am purchasing
Securities with my spouse as co-owner, each of us certifies the
following):
(a)
|
that
I am at least 21 years of age;
|
(b)
|
that
my purchase of Securities will be solely for my own account
and not
for the account of any other person (other than my spouse, if
co-owner);
|
(c)
|
that
the name, home address and social security number or taxpayer
identification number as set forth in this Questionnaire are
true, correct
and complete; and
|
(d)
|
that
one of the following is true and correct (check
one):
|
__________________
*For
purposes of this Questionnaire, the term "net worth" means the excess of
total
assets over total liabilities. In determining income, an investor should
add to
his or her adjusted gross income any amounts attributable to tax-exempt
income
received, losses claimed as a limited partner in any limited partnership,
deductions claimed for depletion, contributions to XXX or Xxxxx retirement
plans, alimony payments and any amount by which income from long-term capital
gains has been reduced in arriving at adjusted gross income.
A-2
Purchaser
|
Spouse,
if Co-Owner
|
||
[ ]
|
[ ]
|
I
am a United States citizen or resident of the United States for
United
States federal income tax purposes.
|
|
[ ]
|
[ ]
|
I
am neither a United States citizen nor a resident of the United
States for
United States federal income tax
purposes.
|
IV.
|
GENERAL
INFORMATION
|
(a)
|
PERSONAL
INFORMATION
|
Purchaser
|
||||||||||||||
Name:
|
||||||||||||||
Social
Security or Taxpayer Identification Number:
|
||||||||||||||
Residence
Address:
|
||||||||||||||
(Number
and Street)
|
||||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
||||||||||||
Residence
Telephone Number:
|
||||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||||
Residence
Facsimile Number:
|
||||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||||
Name
of Business:
|
||||||||||||||
Business
Address:
|
||||||||||||||
(Number
and Street)
|
||||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
||||||||||||
Business
Telephone Number:
|
||||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||||
Business
Facsimile Number:
|
||||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||||
I
prefer to have correspondence sent to:
|
[ ] Residence
|
[ ] Business
|
A-3
E-mail
Address:
|
||
NASD
Affiliation or Association, if any:
|
||
If
none, check here
|
[ ]
|
Spouse,
if Co-Owner
|
||||||||||||
Name:
|
||||||||||||
Social
Security or Taxpayer Identification Number:
|
||||||||||||
Residence
Address (if different from Purchaser’s):
|
||||||||||||
(Number
and Street)
|
||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
||||||||||
Residence
Telephone Number Address (if different from Purchaser’s):
|
||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||
Name
of Business Address (if different from Purchaser’s):
|
||||||||||||
Business
Address Address (if different from Purchaser’s):
|
||||||||||||
(Number
and Street)
|
||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
||||||||||
Business
Telephone Number Address (if different from Purchaser’s):
|
||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||
I
prefer to have correspondence sent to:
|
[ ] Residence
|
[ ] Business
|
||||||||||
NASD
Affiliation or Association, if any:
|
||||||||||||
If
none, check here
|
[ ]
|
V. SIGNATURE
The
Signature Page to this Questionnaire is contained on page A-5, entitled
Individual Signature Page.
A-4
INDIVIDUAL
SIGNATURE PAGE
_____________________________
MAGNETECH
INTEGRATED SERVICES CORP
_____________________________
The
undersigned represents that (a) the information contained in this Questionnaire
is complete and accurate and (b) he/she will telephone Xxxxxx Xxxx at
000-000-0000 immediately if any material change in any of this information
occurs before the acceptance of his/her subscription and will promptly
send
Xxxxxx Xxxx confirmation of such change.
Dollar
Amount of Securities Applied For
|
Date
|
||
|
|
|
|
|
|
Name
(Please Type or Print)
|
|
|
|
|
|
|
|
Signature
|
|
|
|
|
|
|
|
Name
of Spouse if Co-Owner
|
|
|
|
(Please
Type or Print)
|
|
|
|
|
|
|
|
Signature
of Spouse if Co-Owner
|
|
|
|
|
|
|
IF
YOU ARE PURCHASING SECURITIES WITH YOUR SPOUSE, YOU MUST BOTH
SIGN THIS
SIGNATURE PAGE (PAGE A-5).
|
IF
YOU ARE PURCHASING SECURITIES WITH ANOTHER PERSON NOT YOUR SPOUSE,
YOU
MUST EACH FILL OUT A SEPARATE QUESTIONNAIRE. Please
make a photocopy of pages A-1 to A-5 and return both completed
Questionnaires to the Placement Agent in the same
envelope.
|
THE
SECURITIES COMPRISING THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED UNLESS SUCH SECURITIES ARE INCLUDED IN AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT OR AN OPINION OF COUNSEL, CONCURRED
IN BY
COUNSEL TO THE COMPANY, HAS BEEN DELIVERED TO THE EFFECT THAT REGISTRATION
OF
SUCH SECURITIES IS NOT REQUIRED.
A-5
IMPORTANT:
|
Investor
Name: ________________________
|
Please
Complete
|
TRUST
QUESTIONNAIRE
__________________________
MAGNETECH
INTEGRATED SERVICES CORP.
_________________________
Magnetech
Integrated Services Corp
0000
Xxxxx Xxxxxx Xxxxxx
Xxxxx
Xxxx, Xxxxxxx 00000
The
information contained in this Questionnaire is being furnished in order
to
determine whether the undersigned TRUST’s subscription to purchase shares of
Debentures and Warrants (the “Securities”) of Magnetech Integrated
Services Corp (the “Company”) may be accepted.
One
(1)
copy of this Questionnaire should be completed, signed, dated and delivered
to
Xxxxxx Xxxx at Xxxxxxxxxxxx Xxxxxxx Tulcin Xxxxx Inc. 00 Xxxxxxxxx Xxxxxx,
00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000. Please contact Xxxxxx Xxxx at 000-000-0000 if
you have
any questions with respect to this Questionnaire.
ALL
INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY.
The
undersigned TRUST understands, however, that the Company may present this
Questionnaire to such parties as it deems appropriate if called upon to
establish that the proposed offer and sale of the Securities is exempt
from
registration under the Securities Act of 1933, as amended, or meets the
requirements of applicable state securities or “blue sky” laws. Further, the
undersigned TRUST understands that the offering is required to be reported
to
the Securities and Exchange Commission and to various state securities
or “blue
sky” regulators.
NOTE:
RETIREMENT PLANS SHOULD COMPLETE THE QUESTIONNAIRE ON PAGES E-1
to
E-5.
|
I. PLEASE
CHECK STATEMENTS 1 AND 2 BELOW, AS APPLICABLE.
[ ]
|
1.
|
(a)
|
the
TRUST has total assets in excess of $5,000,000; and
|
|
(b)
|
the
TRUST was not formed for the specific purpose of acquiring the
Securities;
and
|
|||
(c)
|
the
purchase by the TRUST is directed by a person who has such knowledge
and
experience in financial and business matters that he/she is capable
of
evaluating the merits and risks of an investment in the
Securities.
|
B-1
[ ]
|
2.
|
The
grantor of the TRUST may revoke the TRUST at any time; the grantor
retains
sole investment control over the assets of the trust and
|
|||
(a)
|
the
grantor is a natural person whose individual net worth* or joint
net worth
with the grantor’s spouse exceeds $1,000,000; or
|
||||
(b)
|
the
grantor is a natural person who had an individual income*
in
excess of $200,000 in each of the previous two years and who
reasonably
expects an individual income in excess of $200,000 for this year;
or
|
||||
(c)
|
the
grantor is a natural person who, together with his or her spouse,
has had
a joint income*
in
excess of $300,000 in each of the previous two years and who
reasonably
expects a joint income in excess of $300,000 for this
year.
|
||||
IF
YOU CHECKED STATEMENT 2 IN SECTION I AND DID NOT CHECK STATEMENT
1, THE
TRUST MUST PROVIDE A COMPLETED INDIVIDUAL INVESTOR QUESTIONNAIRE
(PAGES
A-1 TO A-5) FOR EACH
GRANTOR.
|
II.
|
OTHER
CERTIFICATIONS
|
By
signing the Signature Page, the undersigned certifies the
following:
(a)
|
that
the TRUST’s purchase of the Securities will be solely for the TRUST’s own
account and not for the account of any other person;
|
|
(b)
|
that
the TRUST’s purchase of the Securities is within the investment powers
and
authority of the TRUST (as set forth in the declaration of trust
or other
governing instrument) and that all necessary consents, approvals
and
authorizations for such purchase have been obtained and that
each person
who signs the Signature Page has all requisite power and authority
as
trustee to execute this Questionnaire and the Purchase Agreement
on behalf
of the TRUST;
|
|
(c)
|
that
the TRUST has not been established in connection with either
(i) an
employee benefit plan (as defined in Section 3(3) of ERISA),
whether or
not subject to the provisions of Title I of ERISA, or (ii) a
plan
described in Section 4975(e)(i) of the Internal Revenue
Code;
|
|
(d)
|
that
the TRUST’s name, address of principal office, place of formation and
taxpayer identification number as set forth in this Questionnaire
are
true, correct and complete; and
|
|
(e)
|
that
one of the following is true and correct (check
one):
|
________________________
*For
purposes of this Questionnaire, the term "net worth" means the excess of
total
assets over total liabilities. In determining income, an investor should
add to
his or her adjusted gross income any amounts attributable to tax-exempt
income
received, losses claimed as a limited partner in any limited partnership,
deductions claimed for depletion, contributions to XXX or Xxxxx retirement
plans, alimony payments and any amount by which income from long-term capital
gains has been reduced in arriving at adjusted gross income.
B-2
[ ]
|
(i)
|
the
TRUST is an estate or trust whose income from sources outside
of the
United States is includable in its gross income for United States
federal
tax purposes regardless of its connection with a trade or business
carried
on in the United States.
|
|
[ ]
|
(ii)
|
the
TRUST is an estate or trust whose income from sources outside
the United
States is not includable in its gross income for United States
federal
income taxes purposes regardless of its connection with a trade
or
business carried on in the United
States.
|
III.
|
GENERAL
INFORMATION
|
(a)
|
PROSPECTIVE
PURCHASER (THE TRUST)
|
Name:
|
|||||
Address:
|
|||||
(Number
and Street)
|
|||||
(City)
|
(State)
|
(Zip
Code)
|
|||
Address
for Correspondence (if different):
|
|||||
(Number
and Street)
|
|||||
(City)
|
(State)
|
(Zip
Code)
|
|||
Telephone
Number:
|
|||||
(Area
Code)
|
(Number)
|
||||
State
in which Formed:
|
|||||
Date
of Formation:
|
|||||
Taxpayer
Identification Number:
|
(b)
|
TRUSTEES
WHO ARE EXECUTING THIS QUESTIONNAIRE ON BEHALF OF THE
TRUST
|
Name(s)
of Trustee(s):
|
|||
E-mail
Address:
|
|||
NASD
Affiliation or Association of Trustee(s), if any:
|
|||
If
none, check here
|
[ ]
|
B-3
IV.
|
ADDITIONAL
INFORMATION
|
A
TRUST
must attach a copy of its declaration of trust or other governing instrument,
as
amended, as well as all other documents that authorize the TRUST to invest
in
the Securities. All documentation must be complete and correct.
V.
|
SIGNATURE
|
The
Signature Page to this Questionnaire is contained on page B-5, entitled
Trust
Signature Page.
B-4
TRUST
SIGNATURE PAGE
_______________________
MAGNETECH
INTEGRATED SERVICES CORP.
________________________
1. The
undersigned represents that (a) the information contained in this Questionnaire
is complete and accurate and (b) the TRUST will notify Xxxxxx Xxxx, at
000-000-0000 immediately if any material change in any of this information
occurs before the acceptance of the TRUST’s subscription and will promptly send
Xxxxxx Xxxx written confirmation of such change.
2. The
undersigned TRUST hereby represents and warrants that the persons signing
this
Questionnaire on behalf of the TRUST are duly authorized to acquire the
Securities and sign this Questionnaire and the Purchase Agreement on behalf
of
the TRUST and, further, that the undersigned TRUST has all requisite authority
to purchase such Securities and enter into the Purchase Agreement.
Dollar
Amount of Securities Applied For
|
Date
|
|
Title
of Trust
|
|
|
(Please
Type or Print)
|
||
By:
|
||
Signature
of Trustee
|
||
Name
of Trustee:
|
||
(Please
Type or Print)
|
||
By:
|
||
Signature
of Co-Trustee
|
||
Name
of Co-Trustee:
|
||
(Please
Type or Print)
|
THE
SECURITIES COMPRISING THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED UNLESS SUCH SECURITIES ARE INCLUDED IN AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT OR AN OPINION OF COUNSEL, CONCURRED
IN BY
COUNSEL TO THE COMPANY, HAS BEEN DELIVERED TO THE EFFECT THAT REGISTRATION
OF
SUCH SECURITIES IS NOT REQUIRED.
B-5
IMPORTANT:
|
Investor
Name:_________________
|
Please
Complete
|
PARTNERSHIP
QUESTIONNAIRE
________________________
MAGNETECH
INTEGRATED SERVICES CORP
________________________
Magnetech
Integrated Services Corp
0000
Xxxxx X Xxxxxx Xxxxxxxx Xxx
Xxxxx
000
Xxxxxxx, Xxxxx
00000
The
information contained in this Questionnaire is being furnished in order
to
determine whether the undersigned PARTNERSHIP’s subscription to purchase
shares Debentures amd Warramts (the “Securities”) of Magnetech
Integrated Services Corp (the “Company”) may be accepted.
One
(1)
copy of this Questionnaire should be completed, signed, dated and delivered
to
Xxxxxx Xxxx at Xxxxxxxxxxxx Xxxxxxx Tulcin Xxxxx Inc. 00 Xxxxxxxxx Xxxxxx,
00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000. Please contact Xxxxxx Xxxx at 000-000-0000 if
you have
any questions with respect to this Questionnaire.
ALL
INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY.
The
undersigned PARTNERSHIP understands, however, that the Company may present
this
Questionnaire to such parties as it deems appropriate if called upon to
establish that the proposed offer and sale of the Securities is exempt
from
registration under the Securities Act of 1933, as amended, or meets the
requirements of applicable state securities or “blue sky” laws. Further, the
undersigned PARTNERSHIP understands that the offering is required to be
reported
to the Securities and Exchange Commission and to various state securities
or
“blue sky” regulators.
I.
|
PLEASE
CHECK ANY OF STATEMENTS 1-3 BELOW THAT APPLY TO THE
PARTNERSHIP.
|
[ ]
|
1.
|
Each
of the partners of the undersigned PARTNERSHIP is able to certify
that
such partner meets at least one of the following
conditions:
|
|
(a)
|
The
partner is a natural person whose individual net worth* or
joint net worth with his or her spouse exceeds
$1,000,000.
|
________________________
*For
purposes of this Questionnaire, the term "net worth" means the excess of
total
assets over total liabilities. In determining income, an investor should
add to
his or her adjusted gross income any amounts attributable to tax-exempt
income
received, losses claimed as a limited partner in any limited partnership,
deductions claimed for depletion, contributions to XXX or Xxxxx retirement
plans, alimony payments and any amount by which income from long-term capital
gains has been reduced in arriving at adjusted gross income.
C-1
(b)
|
|
The
partner is a natural person whose individual income*
was in excess of $200,000 in each of the previous two years and
who
reasonably expects an individual income in excess of $200,000
for this
year.
|
|
[ ]
|
2.
|
Each
of the partners of the undersigned PARTNERSHIP is able to certify
that
such partner is a natural person who, together with his or her
spouse, has
had a joint income*
in
excess of $300,000 in each of the previous two years and who
reasonably
expects a joint income in excess of $300,000 for this
year.
|
|
[ ]
|
3.
|
The
undersigned PARTNERSHIP: (a) was not formed for the specific
purpose of
acquiring the Securities; and
(b) has total assets in excess of
$5,000,000.
|
IF
YOU CHECKED STATEMENT 1 OR STATEMENT 2 IN SECTION I AND DID NOT
CHECK
STATEMENT 3, YOU MUST PROVIDE A LETTER SIGNED BY A GENERAL PARTNER
OF THE
UNDERSIGNED PARTNERSHIP LISTING THE NAME OF EACH PARTNER (WHETHER
A
GENERAL OR LIMITED PARTNER) AND THE REASON (UNDER STATEMENT 1
OR STATEMENT
2) SUCH PARTNER QUALIFIES AS AN ACCREDITED INVESTOR (ON THE BASIS
OF NET
WORTH, INDIVIDUAL INCOME OR JOINT INCOME), OR EACH PARTNER MUST
PROVIDE A
COMPLETED INDIVIDUAL INVESTOR QUESTIONNAIRE (PAGES A_1 TO
A_5).
|
II.
|
OTHER
CERTIFICATIONS
|
By
signing the Signature Page, the undersigned certifies the
following:
(a)
|
that
the PARTNERSHIP’s purchase of the Securities will be solely for the
PARTNERSHIP’s own account and not for the account of any other
person;
|
(b)
|
that
the PARTNERSHIP’s name, address of principal office, place of formation
and taxpayer identification number as set forth in this Questionnaire
are
true, correct and complete; and
|
(c)
|
that
one of the following is true and correct (check
one):
|
[ ] (i) the
PARTNERSHIP is a partnership formed in or under the laws of the United
States or
any political subdivision thereof.
[ ] (ii) the
PARTNERSHIP is not a partnership formed in or under the laws of the United
States or any political subdivision thereof.
C-2
III.
|
GENERAL
INFORMATION
|
(a)
|
PROSPECTIVE
PURCHASER (THE PARTNERSHIP)
|
Name:
|
|||
Principal
Place of Business:
|
|||
(Number
and Street)
|
|||
(City)
|
(State) (Zip
Code)
|
Address
for Correspondence (if different):
|
||||||||||||||
(Number
and Street)
|
||||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
||||||||||||
Telephone
Number:
|
||||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||||
Facsimile
Number:
|
||||||||||||||
(Area
Code)
|
(Number)
|
|||||||||||||
State
in which Formed:
|
||||||||||||||
Date
of Formation:
|
||||||||||||||
Taxpayer
Identification Number:
|
||||||||||||||
Number
of Partners:
|
||||||||||||||
E-mail
Address:
|
||||||||||||||
NASD
Affiliation or Association of the PARTNERSHIP, if any:
|
||||||||||||||
If
none, check
here [ ]
|
(b)
|
INDIVIDUAL
WHO IS EXECUTING THIS QUESTIONNAIRE ON BEHALF OF THE
PARTNERSHIP
|
Name:
|
||
Position
or Title:
|
IV.
|
SIGNATURE
|
The
Signature Page to this Questionnaire is contained on page C-4, entitled
Partnership Signature Page.
C-3
PARTNERSHIP
SIGNATURE PAGE
________________________
MAGNETECH
INTEGRATED SERVICES CORP
________________________
1. The
undersigned PARTNERSHIP represents that (a) the information contained in
this
Questionnaire is complete and accurate and (b) the PARTNERSHIP will notify
Xxxxxx Xxxx, at 000-000-0000 immediately if any material change in any
of this
information occurs before the acceptance of the undersigned PARTNERSHIP’s
subscription and will promptly send Xxxxxx Xxxx written confirmation of
such
change.
2. The
undersigned PARTNERSHIP hereby represents and warrants that the person
signing
this Questionnaire and the Purchase Agreement on behalf of the PARTNERSHIP
is a
general partner of the PARTNERSHIP, has been duly authorized by the PARTNERSHIP
to acquire the Securities and sign the Purchase Agreement on behalf of
the
PARTNERSHIP and, further, that the undersigned PARTNERSHIP has all requisite
authority to purchase such Securities and enter into the Purchase
Agreement.
Dollar
Amount of Securities Applied For
|
Date
|
||||
Name
of Partnership
|
|||||
(Please
Type or Print)
|
|||||
By:
|
|||||
(Signature)
|
|||||
Name:
|
|||||
(Please
Type or Print)
|
|||||
Title:
|
|||||
(Please
Type or Print)
|
THE
SECURITIES COMPRISING THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OR 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED UNLESS SUCH SECURITIES ARE INCLUDED IN AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT OR AN OPINION OF COUNSEL, CONCURRED
IN BY
COUNSEL TO THE COMPANY, HAS BEEN DELIVERED TO THE EFFECT THAT REGISTRATION
OF
SUCH SECURITIES IS NOT REQUIRED.
C-4
IMPORTANT:
|
Investor
Name: ___________
|
Please
Complete
|
CORPORATION
QUESTIONNAIRE
______________________
MAGNETECH
INTEGRATED SERVICES CORP.
______________________
Magnetech
Integrated Services Corp.
0000
Xxxxx Xxxxxx Xxxxxx
Xxxxx
Xxxx, Xxxxxxx 00000
The
information contained in this Questionnaire is being furnished in order
to
determine whether the undersigned CORPORATION’s subscription to purchase
shares Debentures and Warrants (the “Securities”) of Magnetech
Integrated Services Corp (the “Company”) may be accepted.
One
(1)
copy of this Questionnaire should be completed, signed, dated and delivered
to
Xxxxxx Xxxx at Xxxxxxxxxxxx Xxxxxxx Tulcin Xxxxx Inc. 00 Xxxxxxxxx Xxxxxx,
00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000. Please contact Xxxxxx Xxxx at 000-000-0000 if
you have
any questions with respect to this Questionnaire.
ALL
INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY.
The
undersigned CORPORATION understands, however, that the Company may present
this
Questionnaire to such parties as it deems appropriate if called upon to
establish that the proposed offer and sale of the Securities is exempt
from
registration under the Securities Act of 1933, as amended, or meets the
requirements of applicable state securities or “blue sky” laws. Further, the
undersigned CORPORATION understands that the offering is required to be
reported
to the Securities and Exchange Commission and to various state securities
or
“blue sky” regulators.
I.
|
PLEASE
CHECK ANY OF STATEMENTS 1-3 BELOW THAT APPLY TO THE
CORPORATION.
|
[ ]
|
1.
|
Each
of the shareholders of the undersigned CORPORATION is able to
certify that
such shareholder meets at least one of the following two
conditions:
|
|
(a)
|
The
shareholder is a natural person whose individual net worth or
joint net
worth with his or her spouse exceeds $1,000,000;
or
|
________________________
*For
purposes of this Questionnaire, the term "net worth" means the excess of
total
assets over total liabilities. In determining income, an investor should
add to
his or her adjusted gross income any amounts attributable to tax-exempt
income
received, losses claimed as a limited partner in any limited partnership,
deductions claimed for depletion, contributions to XXX or Xxxxx retirement
plans, alimony payments and any amount by which income from long-term capital
gains has been reduced in arriving at adjusted gross income.
D-1
(b)
|
The
shareholder is a natural person who had an individual income*
in
excess of $200,000 in each of the previous two years and who
reasonably
expects an individual income in excess of $200,000 for this
year.
|
||
[ ]
|
2.
|
Each
of the shareholders of the undersigned CORPORATION is able to
certify that
such shareholder is a natural person who, together with his or
her spouse,
has had a joint income*
in
excess of $300,000 in each of the previous two years and who
reasonably
expects a joint income in excess of $300,000 for this
year.
|
|
[ ]
|
3.
|
The
undersigned CORPORATION: (a) was not formed for the specific
purpose of
acquiring any Securities; and
(b) has total assets in excess of
$5,000,000.
|
IF
YOU CHECKED STATEMENT 1 OR STATEMENT 2 IN SECTION 1 AND DID NOT
CHECK
STATEMENT 3, YOU MUST PROVIDE A LETTER SIGNED BY AN OFFICER OF
THE
UNDERSIGNED CORPORATION LISTING THE NAME OF EACH SHAREHOLDER
AND THE
REASON (UNDER STATEMENT 1 OR STATEMENT 2) WHY SUCH SHAREHOLDER
QUALIFIES
AS AN ACCREDITED INVESTOR (ON THE BASIS OF NET WORTH, INDIVIDUAL
INCOME OR
JOINT INCOME), OR EACH SHAREHOLDER MUST PROVIDE A COMPLETED INDIVIDUAL
INVESTOR QUESTIONNAIRE (PAGES A_1 TO
A_5).
|
II.
|
OTHER
CERTIFICATIONS
|
By
signing the Signature Page, the undersigned certifies the
following:
(a)
|
that
the CORPORATION’s purchase of the Securities will be solely for the
CORPORATION’s own account and not for the account of any other person or
entity;
|
(b)
|
that
the CORPORATION’s name, address of principal office, place of
incorporation and taxpayer identification number as set forth
in this
Questionnaire are true, correct and complete;
and
|
(c)
|
that
one of the following is true and correct (check
one):
|
[ ]
|
(i)
|
the
CORPORATION is a corporation organized in or under the laws of
the United
States or any political subdivision thereof.
|
|
[ ]
|
(ii)
|
the
CORPORATION is a corporation which is neither created nor organized
in or
under the United States or any political subdivision thereof,
but which
has made an election under either Section 897(i) or 897(k) of
the United
States Internal Revenue Code of 1986, as amended, to be treated
as a
domestic corporation for certain purposes of United States federal
income
taxation (A
COPY OF THE INTERNAL REVENUE SERVICE ACKNOWLEDGMENT OF THE UNDERSIGNED’S
ELECTION MUST BE ATTACHED TO THIS PURCHASE AGREEMENT IF THIS
PROVISION IS
APPLICABLE).
|
D-2
[ ]
|
(iii)
|
neither
(i) nor (ii) above is true.
|
III.
|
GENERAL
INFORMATION
|
(a)
|
PROSPECTIVE
PURCHASER (THE CORPORATION)
|
Name:
|
|||||||||||||||
Principal
Place of Business:
|
|||||||||||||||
(Number
and Street)
|
|||||||||||||||
(City)
|
(State) (Zip
Code)
|
||||||||||||||
Address
for Correspondence (if different):
|
|||||||||||||||
(Number
and Street)
|
|||||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
|||||||||||||
Telephone
Number:
|
|||||||||||||||
(Area
Code)
|
(Number)
|
||||||||||||||
Facsimile
Number:
|
|||||||||||||||
(Area
Code)
|
(Number)
|
||||||||||||||
State
of Incorporation:
|
|||||||||||||||
Date
of Formation:
|
|||||||||||||||
Taxpayer
Identification Number:
|
|||||||||||||||
Number
of Shareholders:
|
|||||||||||||||
NASD
Affiliation or Association of the PARTNERSHIP, if any:
|
|||||||||||||||
If
none, check
here [ ]
|
(b)
|
INDIVIDUAL
WHO IS EXECUTING THIS QUESTIONNAIRE ON BEHALF OF THE
CORPORATION
|
Name:
|
|
Position
or Title:
|
|
Email
Address:
|
IV.
|
SIGNATURE
|
The
Signature Page to this Questionnaire is contained on page D-4, entitled
Corporation Signature Page.
D-3
CORPORATION
SIGNATURE PAGE
_________________________
MAGNETECH
INTEGRATED SERVICES CORP
________________________
1. The
undersigned CORPORATION represents that (a) the information contained in
this
Questionnaire is complete and accurate and (b) the CORPORATION will notify
Xxxxxx Xxxx, at 000-000-0000 immediately if any material change in any
of the
information occurs prior to the acceptance of the undersigned CORPORATION’s
subscription and will promptly send Xxxxxx Xxxx written confirmation of
such
change.
2. The
undersigned CORPORATION hereby represents and warrants that the person
signing
this Questionnaire on behalf of the CORPORATION has been duly authorized
by all
requisite action on the part of the CORPORATION to acquire the Securities
and
sign this Questionnaire and the Purchase Agreement on behalf of the CORPORATION
and, further, that the undersigned CORPORATION has all requisite authority
to
purchase the Securities and enter into the Purchase Agreement.
Dollar
Amount of Securities Applied For
|
Date
|
||||
Name
of Corporation
|
|||||
(Please
Type or Print)
|
|||||
By:
|
|||||
(Signature)
|
|||||
Name:
|
|||||
(Please
Type or Print)
|
|||||
Title:
|
|||||
(Please
Type or Print)
|
THE
SECURITIES COMPRISING THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED UNLESS SUCH SECURITIES ARE INCLUDED IN AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT OR AN OPINION OF COUNSEL, CONCURRED
IN BY
COUNSEL TO THE COMPANY, HAS BEEN DELIVERED TO THE EFFECT THAT REGISTRATION
OF
SUCH SECURITIES IS NOT REQUIRED.
D-4
IMPORTANT:
|
Investor
Name: ___________________
|
Please
Complete
|
RETIREMENT
PLAN QUESTIONNAIRE
___________________________
MAGNETECH
INTEGRATED SERVICES CORP.
__________________________
Magnetech
Integrated Services Corp.
0000 Xxxxx
Xxxxxx Xxxxxx
Xxxxx
Xxxx, Xxxxxxx 00000
The
information contained in this Questionnaire is being furnished in order
to
determine whether the undersigned RETIREMENT PLAN’s subscription to purchase
shares Debentures and Warrants (the “Securities”) of Magnetech Integrated
Services Corp (the “Company”) may be accepted.
One
(1)
copy of this Questionnaire should be completed, signed, dated and delivered
to
Xxxxxx Xxxx at Xxxxxxxxxxxx Xxxxxxx Tulcin Xxxxx Inc. 00 Xxxxxxxxx Xxxxxx,
00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000. Please contact Xxxxxx Xxxx at 000-000-0000 if
you have
any questions with respect to this Questionnaire.
ALL
INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY.
The
undersigned RETIREMENT PLAN understands, however, that the Company may
present
this Questionnaire to such parties as it deems appropriate if called upon
to
establish that the proposed offer and sale of the Securities is exempt
from
registration under the Securities Act of 1933, as amended, or meets the
requirements of applicable state securities or “blue sky” laws. Further, the
undersigned RETIREMENT PLAN understands that the offering is required to
be
reported to the Securities and Exchange Commission and to various state
securities or “blue sky” regulators.
I.
|
PLEASE
CHECK ANY OF THE FOLLOWING STATEMENTS, AS
APPLICABLE.
|
[ ]
1.
|
The
undersigned RETIREMENT PLAN certifies that it is an employee
benefit plan
within the meaning of the Employee Retirement Income Security
Act of 1974
(“ERISA”) and:
|
[ ]
(a)
|
the
investment decisions are made by a plan fiduciary as defined
in Section
3(21) of ERISA that (i) is either a bank, insurance company or
registered
investment advisor or (ii) is a savings and loan association;
or
|
[ ]
(b)
|
The
undersigned RETIREMENT PLAN has total assets in excess of $5,000,000;
or
|
E-1
[ ]
(c)
|
The
undersigned RETIREMENT PLAN is self-directed, with investment
decisions
made solely by persons each of whom satisfies at least one of
the
following conditions:
|
[ ]
|
(i)
|
such
person’s individual net worth* For
purposes of this Questionnaire, the term "net worth" means the
excess of
total assets over total liabilities. In determining income, an
investor
should add to his or her adjusted gross income any amounts attributable
to
tax-exempt income received, losses claimed as a limited partner
in any
limited partnership, deductions claimed for depletion, contributions
to
XXX or Xxxxx retirement plans, alimony payments and any amount
by which
income from long-term capital gains has been reduced in arriving
at
adjusted gross income.
or
joint net worth with his or her spouse exceeds $1,000,000;
or
|
[ ]
|
(ii)
|
such
person had an individual income*
in
excess of $200,000 in each of the previous two years and reasonably
expects an individual income in excess of $200,000 for this year;
or
|
[ ]
|
(iii)
|
such
person together with his or her spouse, had a joint income*
in
excess of $300,000 in each of the previous two years and reasonably
expects a joint income in excess of $300,000 for this
year.
|
[ ]
2.
|
The
undersigned RETIREMENT PLAN certifies that it is an employee
benefit plan,
Xxxxx plan or Individual Retirement Account in which each participant
satisfies at least one of the following
conditions:
|
[ ]
(a)
|
such
person’s individual net worth* or joint net worth with his or her spouse
exceeds $1,000,000; or
|
[ ]
(b)
|
such
person had an individual income* in excess of $200,000 in each
of the
previous two years and reasonably expects an individual income
in excess
of $200,000 for this year; or
|
[ ]
(c)
|
such
person, together with his or her spouse, had a joint income*
in excess of
$300,000 in each of the previous two years and reasonably expects
a joint
income in excess of $300,000 for this
year.
|
____________________
*For
purposes of this Questionnaire, the term "net worth" means the excess
of total
assets over total liabilities. In determining income, an investor should
add to
his or her adjusted gross income any amounts attributable to tax-exempt
income
received, losses claimed as a limited partner in any limited partnership,
deductions claimed for depletion, contributions to XXX or Xxxxx retirement
plans, alimony payments and any amount by which income from long-term
capital
gains has been reduced in arriving at adjusted gross
income.
E-2
IF YOU CHECKED STATEMENT 1(c) OR STATEMENT 2 AND NOT STATEMENT 1(a) OR STATEMENT 1(b), YOU MUST PROVIDE A LETTER SIGNED BY A PERSON DULY AUTHORIZED BY THE RETIREMENT PLAN LISTING, AS APPLICABLE (I) THE NAMES OF THE PERSONS (OR ENTITIES) MAKING THE INVESTMENT DECISIONS, OR (II) THE NAMES OF ALL OF THE PARTICIPANTS IN THE PLAN AND THE REASON (UNDER STATEMENT 1(c) OR STATEMENT 2) SUCH PERSON (OR ENTITY), QUALIFIES AS AN ACCREDITED INVESTOR (ON THE BASIS OF NET WORTH, INDIVIDUAL INCOME, JOINT INCOME OR OTHERWISE), OR EACH SUCH PERSON (OR ENTITY) MUST COMPLETE THE APPROPRIATE QUESTIONNAIRE (i.e. FOR AN INDIVIDUAL, TRUST, PARTNERSHIP OR CORPORATION). |
II.
|
OTHER
CERTIFICATIONS
|
By
signing the Signature Page, the undersigned certifies the
following:
(a)
|
that
the RETIREMENT PLAN’s purchase of the Securities will be solely for the
RETIREMENT PLAN’s own account and not for the account of any other person
or entity;
|
(b)
|
that
the RETIREMENT PLAN’s governing documents duly authorize the type of
investment contemplated herein, and the undersigned is authorized
and
empowered to make such investment on behalf of the RETIREMENT
PLAN.
|
(c)
|
that
one of the following is true and correct (check
one):
|
[ ]
(i)
|
the
RETIREMENT PLAN is a retirement plan whose income from sources
outside of
the United States is includable in its gross income for United
States
federal tax purposes regardless of its connection with a trade
or business
carried on in the United States.
|
[ ]
(ii)
|
the
RETIREMENT PLAN is a retirement plan whose income from sources
outside the
United States is not includable in its gross income for United
States
federal income tax purposes regardless of its connection with
a trade or
business carried on in the United
States.
|
III.
|
GENERAL
INFORMATION
|
(a)
|
PROSPECTIVE
PURCHASER (THE RETIREMENT PLAN)
|
Name:
|
|||||||||||||
Address:
|
|||||||||||||
(Number
and Street)
|
|||||||||||||
(City)
|
(State) (Zip
Code)
|
||||||||||||
Address
for Correspondence (if different):
|
|||||||||||||
(Number
and Street)
|
|||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
|||||||||||
Telephone
Number:
|
|||||||||||||
(Area
Code)
|
(Number)
|
E-3
Address
for Correspondence (if different):
|
|||||||||||||
(Number
and Street)
|
|||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
|||||||||||
Telephone
Number:
|
|||||||||||||
(Area
Code)
|
(Number)
|
Telephone
Number:
|
|||||||||||||
(Area
Code)
|
(Number)
|
Facsimile
Number:
|
||||||||
(Area
Code)
|
(Number)
|
|||||||
State
in which Formed:
|
||||||||
Date
of Formation:
|
||||||||
Taxpayer
Identification Number:
|
(b)
|
INDIVIDUAL
WHO IS EXECUTING THIS QUESTIONNAIRE ON BEHALF OF THE RETIREMENT
PLAN
|
Name:
|
|
Position
or Title:
|
|
Email
Address:
|
IV.
|
ADDITIONAL
INFORMATION
|
THE RETIREMENT PLAN MUST ATTACH COPIES OF ALL DOCUMENTS GOVERNING THE PLAN AS WELL AS ALL OTHER DOCUMENTS AUTHORIZING THE RETIREMENT PLAN TO INVEST IN THE SECURITIES. INCLUDE, AS NECESSARY, DOCUMENTS DEFINING PERMITTED INVESTMENTS BY THE RETIREMENT PLAN, AND DEMONSTRATING AUTHORITY OF THE SIGNING INDIVIDUAL TO ACT ON BEHALF OF THE PLAN. ALL DOCUMENTATION MUST BE COMPLETE AND CORRECT. |
V.
|
SIGNATURE
|
The
Signature Page to this Questionnaire is contained on page E-5, entitled
Retirement Plan Signature Page.
E-4
RETIREMENT
PLAN SIGNATURE PAGE
_________________________
MAGNETECH
INTEGRATED SERVICES CORP.
________________________
1. The
undersigned RETIREMENT PLAN represents that (a) the information contained
in
this Questionnaire is complete and accurate and (b) the RETIREMENT PLAN
will
notify Xxxxxx Xxxx, at 000-000-0000 immediately if any material change
in any of
the information occurs prior to the acceptance of the undersigned RETIREMENT
PLAN’s subscription and will promptly send Xxxxxx Xxxx written confirmation
of
such change.
2. The
undersigned RETIREMENT PLAN hereby represents and warrants that the person
signing this Questionnaire on behalf of the RETIREMENT PLAN has been duly
authorized to acquire the Common Stock and sign this Questionnaire and
the
Purchase Agreement on behalf of the RETIREMENT PLAN and, further, that
the
undersigned RETIREMENT PLAN has all requisite authority to purchase the
Securities and enter into the Purchase Agreement.
Dollar
Amount of Securities Applied For
|
Date
|
||||
Name
of Retirement Plan
|
|||||
(Please
Type or Print)
|
|||||
By:
|
|||||
(Signature)
|
|||||
Name:
|
|||||
(Please
Type or Print)
|
|||||
Title:
|
|||||
(Please
Type or Print)
|
THE
SECURITIES COMPRISING THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED UNLESS SUCH SECURITIES ARE INCLUDED IN AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT OR AN OPINION OF COUNSEL, CONCURRED
IN BY
COUNSEL TO THE COMPANY, HAS BEEN DELIVERED TO THE EFFECT THAT REGISTRATION
OF
SUCH SECURITIES IS NOT REQUIRED.
E-5
IMPORTANT:
|
Investor
Name: ___________________
|
Please
Complete
|
LIMITED
LIABILITY COMPANY QUESTIONNAIRE
______________________
MAGNETECH
INTEGRATED SERVICES CORP.
______________________
Magnetech
Integrated Services Corp.
0000
Xxxxx Xxxxxx Xxxxxx
Xxxxx
Xxxx, Xxxxxxx 00000
The
information contained in this Questionnaire is being furnished in order
to
determine whether the undersigned LIMITED LIABILITY COMPANY’s subscription to
purchase Securities (the “Securities”) of Magnetech Integrated Services
Corp (the “Company”) may be accepted.
One
(1)
copy of this Questionnaire should be completed, signed, dated and delivered
to
Xxxxxx Xxxx at Xxxxxxxxxxxx Xxxxxxx Tulcin Xxxxx Inc. 00 Xxxxxxxxx Xxxxxx,
00xx
Xxxxx,
Xxx Xxxx, Xxx Xxxx 00000. Please contact Xxxxxx Xxxx at 000-000-0000 if
you have
any questions with respect to this Questionnaire.
ALL
INFORMATION CONTAINED IN THIS QUESTIONNAIRE WILL BE TREATED CONFIDENTIALLY.
The
undersigned LIMITED LIABILITY COMPANY understands, however, that the Company
may
present this Questionnaire to such parties as it deems appropriate if called
upon to establish that the proposed offer and sale of the Securities is
exempt
from registration under the Securities Act of 1933, as amended, or meets
the
requirements of applicable state securities or “blue sky” laws. Further, the
undersigned LIMITED LIABILITY COMPANY understands that the offering is
required
to be reported to the Securities and Exchange Commission and to various
state
securities or “blue sky” regulators.
I.
|
PLEASE
CHECK ANY OF STATEMENTS 1-3 BELOW THAT APPLY TO THE LIMITED LIABILITY
COMPANY.
|
[ ]
1.
|
Each
of the members of the undersigned LIMITED LIABILITY COMPANY is
able to
certify that such member meets at least one of the following
two
conditions:
|
(a)
|
The
member is a natural person whose individual net worth* or
joint net worth with his or her spouse exceeds $1,000,000;
or
|
____________________
*For
purposes of this Questionnaire, the term "net worth" means the excess of
total
assets over total liabilities. In determining income, an investor should
add to
his or her adjusted gross income any amounts attributable to tax-exempt
income
received, losses claimed as a limited partner in any limited partnership,
deductions claimed for depletion, contributions to XXX or Xxxxx retirement
plans, alimony payments and any amount by which income from long-term capital
gains has been reduced in arriving at adjusted gross income.
F-1
(b)
|
The
member is a natural person who had an individual income*
in
excess of $200,000 in each of the previous two years and who
reasonably
expects an individual income in excess of $200,000 for this
year.
|
[ ]
2.
|
Each
of the members of the undersigned LIMITED LIABILITY COMPANY is
able to
certify that such member is a natural person who, together with
his or her
spouse, has had a joint income*
in
excess of $300,000 in each of the previous two years and who
reasonably
expects a joint income in excess of $300,000 for this
year.
|
[ ]
3.
|
The
undersigned LIMITED LIABILITY COMPANY: (a) was not formed for
the specific
purpose of acquiring any Securities; and
(b) has total assets in excess of
$5,000,000.
|
[ ]
4.
|
The
sole member of the undersigned LIMITED LIABILITY COMPANY is able
to
certify that such member is an entity which (a) was not formed
for the
specific purpose of acquiring any Common Stock; and
(b) has total assets in excess of
$5,000,000.
|
IF YOU CHECKED STATEMENT 1 OR STATEMENT 2 IN SECTION 1 AND DID NOT CHECK STATEMENT 3, YOU MUST PROVIDE A LETTER SIGNED BY A MANAGER OF THE UNDERSIGNED LIMITED LIABILITY COMPANY LISTING THE NAME OF EACH MEMBER AND THE REASON (UNDER STATEMENT 1 OR STATEMENT 2) WHY SUCH MEMBER QUALIFIES AS AN ACCREDITED INVESTOR (ON THE BASIS OF NET WORTH, INDIVIDUAL INCOME OR JOINT INCOME), OR EACH MEMBER MUST PROVIDE A COMPLETED INDIVIDUAL INVESTOR QUESTIONNAIRE (PAGES A-1 TO A-5). |
II.
|
OTHER
CERTIFICATIONS
|
By
signing the Signature Page, the undersigned certifies the
following:
(a)
|
that
the LIMITED LIABILITY COMPANY’s purchase of the Securities will be solely
for the LIMITED LIABILITY COMPANY’s own account and not for the account of
any other person or entity;
|
(b)
|
that
the LIMITED LIABILITY COMPANY’s name, address of principal office, place
of incorporation and taxpayer identification number as set forth
in this
Questionnaire are true, correct and complete;
and
|
(c)
|
that
one of the following is true and correct (check
one):
|
[ ]
(i)
|
the
LIMITED LIABILITY COMPANY is organized in or under the laws of
the United
States or any political subdivision
thereof.
|
F-2
[ ]
(ii)
|
the
LIMITED LIABILITY COMPANY is neither created nor organized in
or under the
United States or any political subdivision
thereof.
|
III.
|
GENERAL
INFORMATION
|
(a)
|
PROSPECTIVE
PURCHASER (THE LIMITED LIABILITY
COMPANY)
|
Name:
|
|||||||||||||||
Principal
Place of Business:
|
|||||||||||||||
(Number
and Street)
|
|||||||||||||||
(City)
|
(State) (Zip
Code)
|
||||||||||||||
Address
for Correspondence (if different):
|
|||||||||||||||
(Number
and Street)
|
|||||||||||||||
(City)
|
(State)
|
(Zip
Code)
|
|||||||||||||
Telephone
Number:
|
|||||||||||||||
(Area
Code)
|
(Number)
|
||||||||||||||
Facsimile
Number:
|
|||||||||||||||
(Area
Code)
|
(Number)
|
||||||||||||||
E-mail
Address:
|
|||||||||||||||
State
of Formation:
|
|||||||||||||||
Date
of Formation:
|
|||||||||||||||
Taxpayer
Identification Number:
|
|||||||||||||||
Number
of Members:
|
|||||||||||||||
NASD
Affiliation or Association of the PARTNERSHIP, if any:
|
|||||||||||||||
If
none, check
here [ ]
|
(b)
|
INDIVIDUAL
WHO IS EXECUTING THIS QUESTIONNAIRE ON BEHALF OF THE LIMITED
LIABILITY
COMPANY
|
Name:
|
|
Position
or Title:
|
IV.
|
SIGNATURE
|
The
Signature Page to this Questionnaire is contained on page F-4, entitled
LIMITED
LIABILITY COMPANY Signature Page.
F-4
LIMITED
LIABILITY COMPANY SIGNATURE PAGE
_________________________
MAGNETECH
INTEGRATED SERVICES CORP
________________________
1. The
undersigned LIMITED LIABILITY COMPANY represents that (a) the information
contained in this Questionnaire is complete and accurate and (b) the LIMITED
LIABILITY COMPANY will notify Xxxxxx Xxxx, at 000-000-0000 immediately
if any
material change in any of the information occurs prior to the acceptance
of the
undersigned LIMITED LIABILITY COMPANY’s subscription and will promptly send
Xxxxxx Xxxx written confirmation of such change.
2. The
undersigned LIMITED LIABILITY COMPANY hereby represents and warrants that
the
person signing this Questionnaire on behalf of the LIMITED LIABILITY COMPANY
has
been duly authorized by all requisite action on the part of the LIMITED
LIABILITY COMPANY to acquire the Securities and sign this Questionnaire
and the
Purchase Agreement on behalf of the LIMITED LIABILITY COMPANY and, further,
that
the undersigned LIMITED LIABILITY COMPANY has all requisite authority to
purchase the Securities and enter into the Purchase Agreement.
Dollar
Amount of Securities Applied For
|
Date
|
||||
Name
of LIMITED LIABILITY COMPANY
|
|||||
(Please
Type or Print)
|
|||||
By:
|
|||||
(Signature)
|
|||||
Name:
|
|||||
(Please
Type or Print)
|
|||||
Title:
|
|||||
(Please
Type or Print)
|
THE
SECURITIES COMPRISING THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED UNLESS SUCH SECURITIES ARE INCLUDED IN AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT OR AN OPINION OF COUNSEL, CONCURRED
IN BY
COUNSEL TO THE COMPANY, HAS BEEN DELIVERED TO THE EFFECT THAT REGISTRATION
OF
SUCH SECURITIES IS NOT REQUIRED.
F-5
Schedule
2(c)
Capitalization
As
of the
date hereof, the Company is authorized to issue 220,000,000 shares of capital
stock, consisting of 200,000,000 shares of common stock without par value
and
20,000,000 shares of preferred stock without par value. The Company has
issued
and outstanding 97,000,006 shares of common stock.
For
its
services as placement agent in the Bridge Financing and the Private Offering
of
common stock of the Company which began in May, 2004, the Company issued
ten
year warrants to purchase 4,500,000 shares of the common stock of the Company
to
Strasbourger.
Pursuant
to Section 3(d)of the Agreement, upon the closing, the Company will issue
the
Agent’s Warrants, Subscriber Warrants and the Agent’s Shares.
The
Company has received a loan from MFB Financial (from here forward referred
to as
the “Bank”):
Three
Million Dollar ($3,000,000) line of credit, as evidenced by a promissory
note
executed in favor of the bank dated November 1, 2004. The note is payable
on
demand and is secured by the assets of The Company. In addition, Xxxx &
Xxxxxx Xxxxxxx have guaranteed the loan.
The
Company has outstanding loan obligations to Xxxx X. Xxxxxxx, evidenced
by the
following promissory notes:
Promissory
Note, dated effective January 1, 2004, executed by The Company in favor
of Xxxx
X. Xxxxxxx in the principal amount of $3,000,000. The balance of the outstanding
loan obligation as of February 25, 2005 is $3,000,000. The original loan
was
made prior to January 1, 2004.
Promissory
Note, dated effective April 1, 2004, as amended February 21, 2005, executed
by
The Company in favor of Xxxx X. Xxxxxxx in the principal amount of $321,000.
The
note evidences the balance of the outstanding loan obligation due to Xx.
Xxxxxxx
as of February 25, 2005.
Section
2(d)
Subsidiaries
and Investments
1. |
HK
Engine Components, LLC
|
2. |
HK
Machined Parts, LLC, XX Xxxxxx Properties, LLC and HK Cast Products,
LLC
are subsidiaries of HK Engine Components,
LLC.
|
Schedule
2(e)
Financial
Statements
Following
are the Company's unaudited management-compiled financial statements for
the
fiscal year ended December 31, 2004.
Magnetech
Integrated Services Corp. and Subsidiaries
Condensed
Consolidated Balance Sheet
DECEMBER
31, 2004
ASSETS | |||||||
2004
|
|||||||
CURRENT
ASSETS
|
|||||||
Cash
|
$
|
629,039
|
|||||
Accounts
receivable, less allowance for doubtful accounts of $36,336 for
2004 and
$149,473 for 2003
|
5,394,254
|
||||||
Inventories
|
4,240,838
|
||||||
Prepaid
expenses
|
232,448
|
||||||
Other
Current Assets
|
316,814
|
||||||
Total
current assets
|
10,813,393
|
||||||
PROPERTY
AND EQUIPMENT, net
|
2,340,785
|
||||||
OTHER
ASSETS
|
|||||||
Deposits
|
43,538
|
||||||
Patents
and trademarks, net
|
3,159
|
||||||
Covenant
not-to-compete, net
|
0
|
||||||
Other
assets
|
32,112
|
||||||
Total
other assets
|
78,809
|
||||||
Total
Assets
|
$
|
13,232,987
|
|||||
LIABILITIES
AND STOCKHOLDER'S
EQUITY
|
|||||||
CURRENT
LIABILITIES
|
|||||||
Cash
overdraft
|
$
|
520,125
|
|||||
Notes
payable, bank
|
2,509,334
|
||||||
Current
portion of long term debt
|
0
|
||||||
Advances
from Stockholder
|
121,500
|
||||||
Accounts
payable
|
3,208,589
|
||||||
Accrued
expenses
|
724,493
|
||||||
Other
Current Liabilities
|
166,613
|
||||||
Total
current liabilities
|
7,250,654
|
||||||
LONG
TERM LIABILITIES
|
|||||||
Long
term debt, bank
|
0
|
||||||
Long
term debt, Stockholder
|
3,000,000
|
||||||
Total
long term liabilities
|
3,000,000
|
||||||
Total
liabilities
|
10,250,654
|
||||||
COMMITMENTS
|
|||||||
STOCKHOLDER'S
EQUITY
|
|||||||
Capital
stock (note 1)
|
4,300,000
|
||||||
Authorized:
200,000,000 common shares, nil par value
|
|||||||
20,000,000
preferred shares, nil par value
|
|||||||
Issued
and outstanding at December 31, 2004:
|
|||||||
97,000,000
common shares
|
|||||||
Additional
paid in capital
|
2,630,561
|
||||||
Accumulated
deficit
|
(3,948,228
|
)
|
|||||
Total
Stockholder's equity
|
2,982,333
|
||||||
Total
Liabilities and Stockholder's Equity
|
$
|
13,232,987
|
Schedule
2(e)
Magnetech
Integrated Services Corp. and Subsidiaries
Condensed
Consolidated Statements of Operations
For
the year ended December 31, 2004
REVENUES
|
||||
Product
sales
|
$
|
6,816,890
|
||
Service
revenue
|
22,134,229
|
|||
Total
revenues
|
28,951,119
|
|||
COST
OF REVENUES
|
||||
Product
sales
|
4,787,498
|
|||
Service
revenue
|
17,768,438
|
|||
Total
cost of revenues
|
22,555,936
|
|||
Gross
profit
|
6,395,183
|
|||
Selling,
general and administrative expenses
|
6,120,937
|
|||
Income
(Loss) from operations
|
274,246
|
|||
Other
income (expense)
|
||||
Interest
expense
|
(182,793
|
)
|
||
Other
income
|
12,067
|
|||
(170,726
|
)
|
|||
NET
INCOME (LOSS)
|
$
|
103,520
|
Schedule
2(e)
Magnetech
Integrated Services Corp. and Subsidiaries
Condensed
Consolidated Statements of Cash Flows
Year
Ended December 31, 2004
2004 | ||||
OPERATING
ACTIVITIES
|
||||
Net
income (loss)
|
$
|
103,520
|
||
Adjustments
to reconcile net loss to net cash utilized by operating
activities:
|
||||
Depreciation
and amortization
|
463,910
|
|||
Bad
debt
|
20,924
|
|||
Loss
(gain) on sale of assets
|
(1,800
|
)
|
||
Non-cash
interest/rent
|
0
|
|||
Changes
in:
|
||||
Accounts
receivable
|
(2,251,698
|
)
|
||
Inventories
|
(1,467,212
|
)
|
||
Prepaid
expenses
|
(83,815
|
)
|
||
Deposits
and other current assets
|
(327,226
|
)
|
||
Accounts
payable
|
1,240,463
|
|||
Accrued
expenses
|
269,457
|
|||
Net
cash utilized by operating activities
|
(2,033,477
|
)
|
||
INVESTING
ACTIVITIES
|
||||
Acquisition
of property and equipment
|
(929,981
|
)
|
||
Proceeds
from disposal of property and equipment
|
1,800
|
|||
Net
cash utilized by investing activities
|
(928,181
|
)
|
||
FINANCING
ACTIVITIES
|
||||
Cash
overdraft
|
43,088
|
|||
Short
term borrowings, net
|
963,019
|
|||
Advances
from Stockholder
|
101,121
|
|||
Repayment
of long term debt, bank
|
(200,000
|
)
|
||
Issue
of Common Stock
|
2,676,606
|
|||
Borrowings
from Stockholder, long term debt
|
0
|
|||
Net
cash provided by financing activities
|
3,583,834
|
|||
INCREASE
IN CASH
|
622,176
|
|||
Cash,
beginning of year
|
6,863
|
|||
Cash,
end of year
|
$
|
629,039
|
SUPPLEMENTAL
DISCLOSURES OF CASH FLOW INFORMATION:
|
||||
Cash
paid during the year for:
|
||||
Interest
|
$
|
119,845
|
||
SUPPLEMENTAL
DISCLOSURES OF NON-CASH FINANCING ACTIVITIES:
|
||||
Credits
to additional paid in capital for interest/rent
|
$
|
63,000
|
||
Stockholder
loan converted to additional paid in capital
|
$
|
1,740,703
|
Schedule
2(f)
Absence
of Changes
1. |
See
Schedule 2(c) for debt obligations incurred by the
Company.
|
2. |
On
January 5, 2005, the Company made an offer to purchase, through
its
subsidiaries, certain assets and assume certain liabilities of
Hatch &
Xxxx, Inc. and HK Castings, Inc. A revised offer was made on
February 7,
2005. The Company expects to complete the transactions by March
31,
2005.
|
Schedule
2(g)
Title
The
Bank
has a security interest in all of the Company’s inventory, raw materials, work
in process equipment, vehicles, furniture, fixture, accounts, general
intangibles and other assets as evidenced by UCC-1 Financing Statement
number
200400010073835 filed
with the Indiana Secretary of State.
Toyota
Motor Credit Corporation - secured interest in forklift Serial # 68232
as
evidenced by UCC-1 Financing Statement number 20020003805050 filed with
the
Indiana Secretary of State.
Toyota
Motor Credit Corporation - secured interest in forklift Serial # 77921
as
evidenced by UCC-1 Financing Statement number 20020003741433 and
2004000005321946 filed with the Indiana Secretary of State.
Citicorp
Leasing, Inc. - lease dated 5/12/2004 for forklift Serial # P232L.
Neopost
Leasing - leased dated 1/20/2004 for postage meter Serial #
1J35BAI.
Baldor
Electric Company - secured interest in all inventory, equipment and goods
manufactured by or distributed by Baldor and all related accounts receivable
as
evidenced by UCC-1 Financing Statement number 200400011179661 filed with
the
Indiana Secretary of State. Secured interest is limited to outstanding
obligations between Baldor and the Company.
Doble
Engineering Company capital lease dated 7/29/04 for relay test set (F2253
with
F2910 ad F2875).
Railmotive,
Inc. capital lease date 4/29/04 for Xxxxxx fork lift Serial #
C7P3343A.
Schedule
2(h)
Proprietary
Rights
U.S.
Patent No. 6,412,837 (U.S. Serial No. 09/749,366) is not in the name of
the
Company. The Company is attempting to obtain an assignment of the patent
from
its owners: Xxxxxxx X. Xxxxx, Xxxxxx X. Xxxxx, Xxxxx X. Xxxx, Xxxxx X.
Xxxx and
Xxxx Xxxx. The Company is not currently using this patent, but may do so
in the
future.