ESCROW AGREEMENT
Exhibit
(k)(1)
THIS ESCROW AGREEMENT (this
“Agreement”)
made and entered into as of this 27th day of
May, 2009 by and among Xxxxxxx Capital, Inc., a Maryland Corporation (the “Company”), Xxxxxxx
Securities, LLC, a Delaware limited liability company (the “Dealer Manager”), and
UMB Bank, N.A., as Escrow Agent, a national banking association organized and
existing under the laws of the United States of America (the “Escrow
Agent”).
RECITALS
WHEREAS, the Company proposes
to offer and sell (the “Offering”), on a
continuous basis, up to 10,000,000 shares of its common stock, par value $0.001
per share (the “Shares”), at an
initial purchase price of $10.00 per Share, subject to satisfaction of the
Minimum Offering Amount (as defined below), to investors on the terms and
subject to the conditions set forth in the Company’s Registration statement on
Form N-2 (File No. 333-157217), initially filed with the Securities and
Exchange Commission on February 10, 2009 (as amended from time to time, the
“Registration
Statement”), and the prospectus included therein (as amended or
supplemented from time to time, including after the effective date of the
Registration Statement and any post-effective amendment thereto, the “Prospectus”).
WHEREAS, the Dealer Manager
has been engaged by the Company to offer and sell the Shares on a best efforts
basis through a network of participating broker-dealers (the “Dealers”).
WHEREAS, the Company has
agreed that the subscription price paid by subscribers for shares will be
refunded to such subscribers if subscriptions for at least 100,000 shares of
common stock from persons who are not affiliated with the Company or Xxxxxxx
Investments, LLC (the “Advisor”) (the “Minimum Offering
Amount”) have not been received by the date the Offering is scheduled to
conclude in accordance with the terms and conditions with respect thereto set
forth in the Prospectus (the “Offering Conclusion
Date”).
WHEREAS, the Company and the
Dealer Manager desire to establish an escrow account (the “Escrow Account”) as
further described herein in which funds received from subscribers will be
deposited (such funds as may be deposited from time to time in such Escrow
Account, the “Escrowed
Funds”) and the Company and the Dealer Manager desire that UMB Bank, N.A.
act as escrow agent to the Escrow Account and Escrow Agent is willing to act in
such capacity.
WHEREAS, the Escrow Agent has
engaged DST Systems (the “Processing Agent”) to
receive, examine for “good order” and facilitate subscriptions into the Escrow
Account as further described herein and to act as record keeper, maintaining on
behalf of the Escrow Agent the ownership records for the Escrow Account. In so
acting DST shall be acting solely in the capacity of agent for the Escrow Agent
and not in any capacity on behalf of the Company or the Dealer Manager, nor
shall they have any interest other than that provided in this Agreement in
assets in Processing Agent’s possession as the agent of the Escrow
Agent.
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WHEREAS, in order to subscribe
for Shares, a subscriber must deliver the full amount of its subscription:
(i) by check payable to the order of UMB Bank, N.A., as Escrow Agent for
Xxxxxxx Capital, Inc., in U.S. dollars or (ii) by wire transfer of
immediately available funds or Automated ClearingHouse (ACH) in U.S. dollars,
made payable as provided in Section 10(2).
AGREEMENT
NOW,
THEREFORE, the Company, the Dealer Manager and Escrow Agent agree to the terms
of this Agreement as follows:
1. Establishment of Escrow
Account; Offering Period; Escrow Period. On or prior to the commencement
of the offering of Shares pursuant to the Registration Statement and the
Prospectus, the Company shall establish the Escrow Account with the Escrow
Agent, which shall be entitled “UMB Bank, N.A., as Escrow Agent for Xxxxxxx
Capital, Inc.” This Agreement shall be effective on the date on which
the Registration Statement becomes effective. As used herein, the
term “Offering
Period” shall mean the period commencing upon the effectiveness of this
Agreement and continuing until the earlier of (i) the Offering Conclusion Date
and (ii) the termination of the Offering by the Company. As used
herein, the term “Escrow Period” shall
mean the period commencing upon the effectiveness of this Agreement and
continuing until the earlier of (i) the date upon which the Escrow Agent
receives confirmation from the Company and the Dealer Manager that the Company
has satisfied the Minimum Offering Amount, (ii) the Offering Conclusion Date,
and (iii) the termination of the Offering by the Company prior to satisfaction
of the Minimum Offering Amount.
2. Operation of the
Escrow.
(a) Deposits in the Escrow
Account. During the Offering Period, persons subscribing to purchase
Shares will be instructed by the Company, the Dealer Manager and the Dealers to
make checks for subscriptions payable to the order of “UMB Bank, N.A., as Escrow
Agent for Xxxxxxx Capital, Inc.” Completed subscription agreements
and checks in payment for the purchase price shall be remitted to the P.O. Box
designated for the receipt of such agreements and funds, and wires or Automated
Clearing House (ACH) payments shall be transmitted directly to the Escrow
Account. To the extent that subscription agreements and payments are remitted by
the Company or the Dealer Manager, the Company or the Dealer Manager, as
applicable, will furnish to the Escrow Agent a list detailing information
regarding such subscriptions as set forth in Exhibit
B. The Processing Agent will deliver by noon the following
business day all monies received in good order from subscribers (or from the
Dealer Manager or Dealers transmitting moneys and subscriptions from
subscribers) for the payment of Shares to the Escrow Agent for deposit in the
Escrow Account. Deposits shall be held in the Escrow Account until such funds
are disbursed in accordance with this paragraph 2 hereof. Prior to disbursement
of the funds deposited in the Escrow Account, such funds shall not be subject to
claims by creditors of the Company or any of its affiliates. If any of the
instruments of payment are returned to the Escrow Agent for nonpayment prior to
receipt of the Break Escrow Affidavit (as described below), the Escrow Agent
shall promptly notify the Processing Agent and the Company in writing via mail,
email or facsimile of such nonpayment, and the Escrow Agent is authorized to
debit the Escrow Account, as applicable in the amount of such returned payment
as well as any interest earned on the amount of such payment and the Processing
Agent shall delete the appropriate account from the records maintained by the
Processing Agent. The Processing Agent will maintain a written account of each
sale, which account shall set forth, among other things, the following
information: (i) the subscriber’s name and address, (ii) the number of
Shares purchased by such subscriber, and (iii) the amount paid by such
subscriber for such Shares. During the Escrow Period neither the Company nor the
Dealer Manager will be entitled to any principal funds received into the Escrow
Account.
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(b) Distribution of the Escrowed
Funds. If at any time on or prior to the Offering Conclusion Date,
subscriptions sufficient to satisfy the Minimum Offering Amount have been
received, then upon the happening of such event, the principal amount of the
Escrowed Funds, together with any interest or other income thereon, shall remain
in the Escrow Account until the Escrow Agent receives written direction provided
by the Company and the Dealer Manager instructing the Escrow Agent to deliver
the principal amount of such Escrowed Funds, together with any interest or other
income thereon, as the Company shall direct. An affidavit or certification from
an officer of the Company and an officer of the Dealer Manager to the Escrow
Agent and Processing Agent stating that at least subscriptions for the Minimum
Offering have been timely received, shall constitute sufficient evidence for the
purpose of this Agreement that such event has occurred (the “Break Escrow
Affidavit”). The Affidavit shall indicate (i) the date on which
subscriptions for the Minimum Offering were received and (ii) the actual
total number of Shares sold as of such date. Thereafter, the Escrow Agent shall
release the principal amount of such Escrowed Funds, together with any interest
or other income thereon, as may be held in the Escrow Account from time to time,
including funds received during the Offering Period but subsequent to the Escrow
Period, as directed by the Company pursuant to written instructions that the
Company shall provide to the Escrow Agent from time to time.
If the
Escrow Agent has not received a Break Escrow Affidavit on or prior to the
Offering Conclusion Date, the Processing Agent shall provide the Escrow Agent
the information needed to return the Escrowed Funds, together with any interest
or other income thereon, to each respective subscriber, and the Escrow Agent
shall promptly create and dispatch checks and wires drawn on the Escrow Account
to return the Escrowed Funds, together with any interest or other income
thereon, without deduction, penalty or expense, to the respective subscribers,
and the Escrow Agent shall notify the Company and the Dealer Manager of its
distribution of the funds. The subscription payments returned to each
subscriber shall be free and clear of any and all claims of the Company or any
of its creditors.
3. Escrowed Funds. Upon
receipt of the Escrowed Funds, the Escrow Agent shall hold the Escrowed Funds in
escrow pursuant to the terms of this Agreement. Until such time as the Escrowed
Funds shall be distributed by the Escrow Agent as provided herein, the Escrowed
Funds shall be invested and reinvested by the Escrow Agent in bank accounts or
bank money market accounts.
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The
Escrow Agent shall be entitled to sell or redeem any such investment as
necessary to make any distributions required under this Agreement and shall not
be liable or responsible for any loss resulting from any such sale or
redemption.
Interest
or other income, if any, resulting from the investment of the Escrowed Funds
during the Escrow Period shall be retained by the Escrow Agent in the Escrow
Account, and shall be distributed according to this Agreement.
The
Escrow Agent shall provide to the Company monthly statements (or more frequently
as reasonably requested by the Company) on the account balance in the Escrow
Account and the activity in the account since the last report.
4. Duties of the Escrow
Agent. The Escrow Agent shall have no duties or responsibilities other
than those expressly set forth in this Agreement, and no implied duties or
obligations shall be read into this Agreement against the Escrow Agent. The
Escrow Agent is not a party to, or bound by, the any other agreement among the
other parties hereto, and the Escrow Agent’s duties shall be determined solely
by reference to this Agreement. The Escrow Agent shall have no duty to enforce
any obligation of any person, other than as provided herein. The Escrow Agent
shall be under no liability to anyone by reason of any failure on the part of
any party hereto or any maker, endorser or other signatory of any document or
any other person to perform such person’s obligations under any such
document.
5. Liability of the Escrow
Agent and the Processing Agent; Indemnification. The Escrow Agent acts
hereunder as a depository only. The Escrow Agent is not responsible or liable in
any manner for the sufficiency, correctness, genuineness or validity of this
Escrow Agreement or with respect to the form of execution of the same. Each of
the Escrow Agent and the Processing Agent shall not be liable for any action
taken or omitted by it, or any action suffered by it to be taken or omitted, in
good faith, and in the exercise of its own best judgment, and may rely
conclusively and shall be protected in acting upon any order, notice, demand,
certificate, opinion or advice of counsel (including counsel chosen by the
Escrow Agent or the Processing Agent), statement, instrument, report or other
paper or document (not only as to its due execution and the validity and
effectiveness of its provisions, but also as to the truth and acceptability of
any information therein contained) which is believed by the Escrow Agent or the
Processing Agent to be genuine and to be signed or presented by the proper
person(s). Each of the Escrow Agent and the Processing Agent shall not be held
liable for any error in judgment made in good faith by an officer or employee of
either unless it shall be proved that the Escrow Agent or the Processing Agent,
as appropriate, was grossly negligent or reckless in ascertaining the pertinent
facts or acted intentionally in bad faith. The Escrow Agent shall not be bound
by any notice of demand, or any waiver, modification, termination or rescission
of this Agreement or any of the terms hereof, unless evidenced by a writing
delivered to the Escrow Agent signed by the proper party or parties and, if the
duties or rights of the Escrow Agent are affected, unless it shall give its
prior written consent thereto.
Either of
the Escrow Agent and the Processing Agent may consult legal counsel and shall
exercise reasonable care in the selection of such counsel, in the event of any
dispute or question as to the construction of any provisions hereof or its
duties hereunder, and it shall incur no liability and shall be fully protected
in acting in accordance with the reasonable opinion or instructions of such
counsel.
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Each of
the Escrow Agent and the Processing Agent shall not be responsible, may
conclusively rely upon and shall be protected, indemnified and held harmless by
the Company, for the sufficiency or accuracy of the form of, or the execution,
validity, value or genuineness of any document or property received, held or
delivered by it hereunder, or of the signature or endorsement thereon, or for
any description therein; nor shall the Escrow Agent or the Processing Agent be
responsible or liable in any respect on account of the identity, authority or
rights of the persons executing or delivering or purporting to execute or
deliver any document, property or this Agreement.
In the
event that either the Escrow Agent or the Processing Agent shall become involved
in any arbitration or litigation relating to the Escrowed Funds, each is
authorized to comply with any decision reached through such arbitration or
litigation.
The
Company, hereby agrees to indemnify both the Escrow Agent and the Processing
Agent for, and to hold it harmless against any loss, liability or expense
incurred in connection herewith without gross negligence, recklessness or
willful misconduct on the part of either of the Escrow Agent or the Processing
Agent, including without limitation legal or other fees arising out of or in
connection with its entering into this Agreement and carrying out its duties
hereunder, including without limitation the costs and expenses of defending
itself against any claim of liability in the premises or any action for
interpleader. Neither the Escrow Agent, nor the Processing Agent, shall be under
any obligation to institute or defend any action, suit, or legal proceeding in
connection herewith, unless first indemnified and held harmless to its
satisfaction in accordance with the foregoing, except that neither shall be
indemnified against any loss, liability or expense arising out of its own gross
negligence, recklessness or willful misconduct. Such indemnity shall survive the
termination or discharge of this Agreement or resignation of the Escrow
Agent.
6. The Escrow Agent’s
Fee. Escrow Agent shall be entitled to fees and expenses for its regular
services as Escrow Agent as set forth in Exhibit A.
Additionally, Escrow Agent is entitled to reasonable fees for extraordinary
services and reimbursement of any reasonable out of pocket and extraordinary
costs and expenses related to its obligations as Escrow Agent under this
Agreement, including, but not limited to, reasonable attorneys’ fees. All of the
Escrow Agent’s compensation, costs and expenses shall be paid by the
Company.
7. Security Interests.
No party to this Escrow Agreement shall grant a security interest in any monies
or other property deposited with the Escrow Agent under this Escrow Agreement,
or otherwise create a lien, encumbrance or other claim against such monies or
borrow against the same.
8. Dispute. In the event
of any disagreement between the undersigned or the person or persons named in
the instructions contained in this Agreement, or any other person, resulting in
adverse claims and demands being made in connection with or for any papers,
money or property involved herein, or affected hereby, the Escrow Agent shall be
entitled to refuse to comply with any demand or claim, as long as such
disagreement shall continue, and in so refusing to make any delivery or other
disposition of any money, papers or property involved or affected hereby, the
Escrow Agent shall not be or become liable to the undersigned or to any person
named in such instructions for its refusal to comply with such conflicting or
adverse demands, and the Escrow Agent shall be entitled to refuse and refrain to
act until: (a) The rights of the adverse claimants shall have been fully
and finally adjudicated in a Court assuming and having jurisdiction of the
parties and money, papers and property involved herein or affected hereby, or
(b) All differences shall have been adjusted by agreement and the Escrow
Agent shall have been notified thereof in writing, signed by all the interested
parties.
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9. Resignation of Escrow
Agent. Escrow Agent may resign or be removed, at any time, for any
reason, by written notice of its resignation or removal to the proper parties at
their respective addresses as set forth herein, at least 60 days before the date
specified for such resignation or removal to take effect; upon the effective
date of such resignation or removal:
(a)
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All
cash and other payments and all other property then held by the Escrow
Agent hereunder shall be delivered by it to such successor escrow agent as
may be designated in writing by the Company, whereupon the Escrow Agent’s
obligations hereunder shall cease and
terminate;
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(b)
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If
no such successor escrow agent has been designated by such date, all
obligations of the Escrow Agent hereunder shall, nevertheless, cease and
terminate, and the Escrow Agent’s sole responsibility thereafter shall be
to keep all property then held by it and to deliver the same to a person
designated in writing by the Company or in accordance with the directions
of a final order or judgment of a court of competent
jurisdiction.
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(c)
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Further,
if no such successor escrow agent has been designated by such date, the
Escrow Agent may petition any court of competent jurisdiction for the
appointment of a successor agent; further the Escrow Agent may pay into
court all monies and property deposited with Escrow Agent under this
Agreement.
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10. Notices. All notices,
demands and requests required or permitted to be given under the provisions
hereof must be in writing and shall be deemed to have been sufficiently given,
upon receipt, if (i) personally delivered, (ii) sent by telecopy and
confirmed by phone or (iii) mailed by registered or certified mail, with
return receipt requested, delivered to the addresses set forth below, or to such
other address as a party shall have designated by notice in writing to the other
parties in the manner provided by this paragraph:
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(1) If to Company:
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Xxxxxxx
Capital, Inc.
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0000
XXX Xxxxxxx, Xxxxx 0000
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Xxxxxxxxx
Xxxxxxx, XX 00000
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Telephone:
(000)-000-0000
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Attn:
Xxxxxxx X. Xxxxxxx
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Company
Wire Instructions:
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Xxxxxx
Street Bank & Trust
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ABA
Routing Number: 000000000
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Account
Number: 00000000
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FFC
Account Name: Xxxxxxx Capital, Inc.
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(2) If to the Escrow Agent:
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UMB
Bank, N.A.
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0000
Xxxxx Xxxx., 0xx Xxxxx
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Mail
Stop: 1020409
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Xxxxxx
Xxxx, Xxxxxxxx 00000
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Attention:
Xxxx Xxxxxxx,
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Corporate
Trust
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Telephone:
(000) 000-0000
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Facsimile:
(000) 000-0000
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Escrow
Agent Wiring Instructions:
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UMB
Bank, N.A.
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ABA
Routing Number: 000000000
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Account
Number: 9871879712
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Account
Name: UMB Bank, N.A., as Escrow Agent for Xxxxxxx Capital,
Inc.
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Checks
Payable Information:
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UMB
Bank as Escrow Agent for Xxxxxxx Capital, Inc..
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Attention:
Xxxx Xxxxxxx, Corporate Trust
0000
Xxxxx Xxxxxxxxx, 0xx
Xxxxx
M/S
1020409
Xxxxxx
Xxxx, Xxxxxxxx 00000
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(3)
If to Dealer Manager:
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Xxxxxxx
Securities, LLC
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0000
XXX Xxxxxxx, Xxxxx 0000
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Xxxxxxxxx
Xxxxxxx, XX 00000
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Telephone:
(000)-000-0000
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Attn:
Xxxx X. Xxxxxxx
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11. Governing Law. This
Agreement shall be construed and enforced in accordance with the laws of the
State of Missouri without regard to the principles of conflicts of
law.
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12. Binding Effect;
Benefit. This Agreement shall be binding upon and inure to the benefit of
the permitted successors and assigns of the parties hereto.
13. Modification. This
Agreement may be amended, modified or terminated at any time by a writing
executed by the Company, the Dealer Manager and the Escrow Agent.
14. Assignability. This
Agreement shall not be assigned by the Escrow Agent without the Company’s prior
written consent.
15. Counterparts. This
Agreement may be executed in one or more counterparts, each of which will be
deemed an original, but all of which together will constitute one and the same
instrument. Copies, telecopies, facsimiles, electronic files and other
reproductions of original executed documents shall be deemed to be authentic and
valid counterparts of such original documents for all purposes, including the
filing of any claim, action or suit in the appropriate court of
law.
16. Headings. The section
headings contained in this Agreement are inserted for convenience only, and
shall not affect in any way, the meaning or interpretation of this
Agreement.
17. Severability. This
Agreement constitutes the entire agreement among the parties and supersedes all
prior and contemporaneous agreements and undertakings of the parties in
connection herewith. No failure or delay of the Escrow Agent in exercising any
right, power or remedy may be, or may be deemed to be, a waiver thereof; nor may
any single or partial exercise of any right, power or remedy preclude any other
or further exercise of any right, power or remedy. In the event that any one or
more of the provisions contained in this Agreement, shall, for any reason, be
held to be invalid, illegal or unenforceable in any respect, then to the maximum
extent permitted by law, such invalidity, illegality or unenforceability shall
not affect any other provision of this Agreement.
18. Earnings Allocation; Tax
Matters; Patriot Act Compliance; OFAC Search Duties. The Company or its
agent shall be responsible for all tax reporting under this Escrow Agreement.
The Company shall provide to Escrow Agent upon the execution of this Agreement
any documentation requested and any information reasonably requested by the
Escrow Agent to comply with the USA Patriot Act of 2001, as amended from time to
time. The Escrow Agent, or its agent, shall complete an OFAC search, in
compliance with its policy and procedures, of each subscription check and shall
inform the Company if a subscription check fails the OFAC search. The
Dealer Manager shall provide a copy of each subscription check in order that the
Escrow Agent, or its agent, may perform such OFAC search.
19. Miscellaneous. This
Agreement shall not be construed against the party preparing it, and shall be
construed without regard to the identity of the person who drafted it or the
party who caused it to be drafted and shall be construed as if all parties had
jointly prepared this Agreement and it shall be deemed their joint work product,
and each and every provision of this Agreement shall be construed as though all
of the parties hereto participated equally in the drafting hereof; and any
uncertainty or ambiguity shall not be interpreted against any one party. As a
result of the foregoing, any rule of construction that a document is to be
construed against the drafting party shall not be applicable.
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20. Third Party
Beneficiaries. The Processing Agent shall be a third party beneficiary
under this Agreement, entitled to enforce any rights, duties or obligations owed
to it under this Agreement notwithstanding the terms of any other agreements
between the Processing Agent and any Party hereto.
21. Termination of the Escrow
Agreement. This Escrow Agreement, except for Sections 5 and 9 hereof,
which shall continue in effect, shall terminate upon written notice from the
Company to the Escrow Agent. Unless otherwise provided, final
termination of this Escrow Agreement shall occur on the date that all funds held
in the Escrow Account are distributed either (a) to the Company or to
subscribers and the Company has informed the Escrow Agent in writing to close
the Escrow Account or (b) to a successor escrow agent upon written instructions
from the Company.
22. Relationship of
Parties. The Company, the Dealer Manager and the Escrow
Agreement are unaffiliated parties, and this Agreement does not create any
partnership or joint venture among them. Subscriptions made by the
Dealer Manager or any of its affiliated persons shall be counted toward reaching
the Minimum Offering.
[SIGNATURE
PAGES FOLLOW]
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IN
WITNESS WHEREOF, the undersigned have caused
this Agreement to be executed by their duly authorized representatives as of the
date first written hereinabove:
COMPANY: | |||
Xxxxxxx Capital, Inc. | |||
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By:
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/s/ Xxxxxxx X. Xxxxxxx | |
Name: Xxxxxxx X. Xxxxxxx | |||
Title: President and Chief Executive Officer | |||
DEALER MANAGER: | |||
Xxxxxxx Securities, LLC | |||
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By:
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/s/ Xxxx X. Xxxxxxx | |
Name: Xxxx X. Xxxxxxx | |||
Title: Principal | |||
ESCROW AGENT: | |||
UMB BANK, N.A. | |||
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By:
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/s/ Xxxx Xxxxxxx | |
Name: Xxxx Xxxxxxx | |||
Title:
Corporate Trust Unit
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EXHIBIT
A
ESCROW
FEES AND EXPENSES
Acceptance
Fee
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Review
escrow agreement and establish account
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$
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3,000
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Annual
Fee
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Maintain
account
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$
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3,000
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Transaction
Fees
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(a)
per outgoing wire transfer
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$
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35.00
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(b)
per Form 1099 (Int., B or Misc.)
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$
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10.00
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*
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* Not anticipated to be charged |
Fees
specified are for the regular, routine services contemplated by the Escrow
Agreement, and any additional or extraordinary services, including, but not
limited to disbursements involving a dispute or arbitration, or administration
while a dispute, controversy or adverse claim is in existence, will be charged
based upon time required at the then standard hourly rate. In addition to the
specified fees, all expenses related to the administration of the Escrow
Agreement (other than normal overhead expenses of the regular staff) such as,
but not limited to, travel, postage, shipping, courier, telephone, facsimile,
supplies, legal fees, accounting fees, etc., will be reimbursable. Acceptance
and first year annual fees will be payable at the initiation of the escrow and
annual fees will be payable in advance thereafter. Other fees and expenses will
be billed as incurred.
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EXHIBIT
B
Form of
Subscriber List
Pursuant
to the Escrow Agreement dated as of _________ ___, 2009, by and among
__________________________. (the “Company”), UMB Bank,
N.A., as escrow agent (the “Escrow Agent”), and
_______________ (the “Dealer Manager”), the
Dealer Manager hereby notifies the Escrow Agent that, as of the date set forth
below, the following Subscribers have submitted subscription funds for the
purchase of shares of common stock of the Company (the “Shares”), such
subscription funds have been deposited with Escrow Agent in accordance with the
Escrow Agreement:
1.
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Name
of Subscriber
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Address
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Tax
Identification Number
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Number
of Shares subscribed for
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Amount
of money paid and deposited with Escrow Agent
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2.
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Name
of Subscriber
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Address
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Tax
Identification Number
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Number
of Shares subscribed for
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Amount
of money paid and deposited with Escrow Agent
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…
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Name
of Subscriber
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Address
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Tax
Identification Number
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Number
of Shares subscribed for
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Amount
of money paid and deposited with Escrow
Agent
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_____________________
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By:____________________________________
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Name:_________________________________
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Title:__________________________________
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Date:
______________________ ____,
200___
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