COMPELLENT TECHNOLOGIES, INC. EXECUTIVE EMPLOYMENT AGREEMENT
Exhibit 10.11
COMPELLENT TECHNOLOGIES, INC.
This Executive Employment Agreement (the “Agreement”), originally entered into as of
the 12th day of July, 2002, is by and between Compellent Technologies, Inc., a
Delaware corporation (“the Company”), and Xxxxxxxx X. Xxxxxxx (“Executive”), an individual
residing in the State of Minnesota, is hereby amended and restated, effective as of the
16th day of August, 2007.
Recitals
The Company desires to employ Executive and avail itself of the unique skills, talents,
contacts, judgment and knowledge of Executive;
Executive desires to be employed by the Company pursuant to the terms and conditions described
more fully below:
Now, Therefore, in consideration of the foregoing and the mutual covenants set forth
herein, the Company and Executive, intending to be legally bound, hereby agree as follows:
Agreements
1. Employment and Duties. Subject to the terms and conditions set forth herein, Executive
shall serve as the Company’s Chief Technology Officer, with those duties set forth on Schedule l
attached hereto. Executive shall devote his full working time and efforts to the Company’s
business, to the exclusion of all other employment or active participation in other business
interests, unless otherwise consented to in writing by the disinterested members of the Board of
Directors of the Company (the “Board”). The Executive may not serve as a director on any board of
directors without the unanimous written consent of the Board.
2. Term of Employment. Executive’s employment with Company shall be at will and this
Agreement may be unilaterally terminated by either party subject to the terms of Section 8 of this
Agreement.
3. Compensation. For all services rendered by Executive pursuant to this Agreement, including
serving on the Board of Directors of the Company or any of its subsidiaries or affiliates, if
required by the Company, the Company shall compensate Executive pursuant to the terms and
conditions as initially listed in Schedule 2 attached hereto, or as it may be adjusted from time to
time hereafter.
4. Confidential Information.
A. Executive acknowledges that it is the policy of the Company (for purposes of this Section
4, the term “the Company” shall also refer to any subsidiary, parent or other affiliate of the
Company, subsidiaries of the parent company, any holding company related to the Company or its
parent and any subsidiaries thereto) to maintain as secret and confidential all valuable and unique
information heretofore or hereafter acquired, developed or used by the Company relating to the
business, operations, employees, and/or clients of the Company which
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gives the Company a competitive advantage in its industry, including, without limitation,
information about net costs, profits, markets, suppliers, sales products, key personnel, pricing
policies, operational methods, technical processes, computer software, computer programs,
blue-prints, algorithms, research and development materials and other business affairs and methods
and other information not readily available to the public, operating manuals, computer software for
the Company’s market tracking system, financial statements, forecasts and operating data and
business plans (all such information is hereinafter referred to as “Confidential Information”).
Executive recognizes that the services to be performed by him are special and unique, and that by
reason of Executive’s duties, he will acquire and have access to Confidential Information.
Executive recognizes that all such Confidential Information is the property of the Company. In
consideration of the Company’s entering into this Agreement, Executive agrees that during the term
of this Agreement and at all times thereafter: (i) except in connection with the performance of his
duties, Executive shall never, directly or indirectly, use, publish, disseminate or otherwise
disclose any Confidential Information obtained before or during Executive’s employment by the
Company (whether obtained prior to, during or after the term of this Agreement) without the prior
written consent of the Company’s Board of Directors; and (ii) during the term of this Agreement, he
shall exercise all due and diligent precautions to protect the integrity of the Company’s mailing
lists and sources thereof, statistical data and compilations, agreements, contracts, manuals or
other documents embodying any Confidential Information.
B. The provisions of this Section 4 shall not apply to Confidential Information (i) which is
known generally to the public, (ii) which otherwise comes into the public domain without the fault
of Executive, or (iii) which Executive obtains from sources other than the Company or its
employees, agents or representatives (provided that such exception shall not be applicable to
Confidential Information disclosed to Executive in Executive’s position as a director, officer and
employee of the Company).
5. Non-competition.
A. During the term of this Agreement and for a period of six (6) months after the termination
of this Agreement for any reason (or for such a lesser period of time as may be determined by a
court of law or equity to be a reasonable limitation on Executive), unless the Company is in
material default of the provisions of Section 9 hereof, as applicable, Executive shall not do the
following:
(i) Solicit, directly or indirectly, any director, officer or employee of the Company (for
purposes of this Section 5, the term “the Company” shall also refer to any subsidiary, parent or
other affiliate of the Company, subsidiaries of the parent company, any holding company related to
the Company or its parent and any subsidiaries thereto) to discontinue that individual’s status of
employment with the Company, nor to become employed in any activity similar to or competitive with
the business of the Company being conducted at the time of termination of this Agreement within the
territories in which the Company conducts its business operations;
(ii) Solicit or cause or authorize, directly or indirectly to be solicited, for or on behalf
of Executive or any third party, from others who are customers of the Company
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or active prospects, any business which is competitive with the Company within the territories
in which the Company conducts its business operations;
(iii) Enter into or engage, directly or indirectly, in any business that directly competes
with the business conducted by the Company within the territories in which the Company conducts its
business operations;
(iv) Solicit, request, advise, or induce any current or potential customer, supplier, or other
business contact of the Company to cancel, curtail, or otherwise adversely change its relationship
with the Company;
(v) Promote or assist, financially or otherwise, any person or entity engaged in any business
that directly competes with the business conducted by the Company within the territories in which
the Company conducts its business operations; or
(vi) Engage in or invest in, own, manage, operate, finance, control, consult with or
participate in the ownership, management, operation, financing or control of, be employed by,
associated with, or in any manner connected with, lend Executive’s name to or render services or
advice to any business that directly competes with the business conducted by the Company within the
territories in which the Company conducts its business operations.
B. Nothing herein shall prohibit Executive from holding shares or stock or warrants or
debentures in a company listed on a nationally or internationally recognized stock exchange, if
Executive owns no more than five percent (5%) of such company’s shares entitled to vote at a
meeting of its shareholders.
6. Remedies for Violations of Sections 4 and 5.
A. If the covenants contained in Sections 4 or 5 are violated, Executive acknowledges and
agrees that such violation will cause irreparable damage to the Company, that the remedy at law of
the Company will be inadequate and that the Company shall, in addition to, but not in limitation
of, any other rights or remedies available at law or in equity, be entitled to injunctive relief
and/or specific performance without the posting of a bond or other security without the necessity
of proving actual damage.
B. The parties hereto acknowledge that the provisions of Sections 4
and 5 shall survive the termination of this Agreement.
C. If the duration of, the scope of or any business activity covered by any provision of
Sections 4 or 5 is in excess of what is determined to be valid and enforceable under applicable
law, such provision shall be construed to cover only that duration, scope or activity that is
determined to be valid and enforceable. Executive hereby acknowledges that Sections 4 and 5 shall
be given the construction which renders the provisions valid and enforceable to the maximum extent,
not exceeding their express terms, possible under applicable law.
7. Proprietary Information and Inventions Agreement. Executive affirms his obligations under
the Proprietary Information and Inventions Agreement (the “Proprietary
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Agreement”) that is attached as Schedule 3 hereto, which he has previously executed in
connection with the commencement of his employment.
8. Termination.
A. Voluntary Termination. Except as provided in Sections 8.B., C., D. and E., each party
hereto may terminate this Agreement by giving to the other party no less than sixty (60) days prior
written notice of the party’s intent to terminate. If Executive voluntarily terminates this
Agreement without Good Reason then the Company shall have no further liability to Executive for any
payment, compensation or benefit whatsoever. If the Company voluntarily terminated this Agreement
without Cause (as set forth in Section 8.D. hereof) or Executive terminates this Agreement for Good
Reason (as set forth in Section 8.E.) then Executive shall be entitled to a severance payment as
described in Section 9 of this Agreement.
B. By Death. This Agreement shall be terminated automatically upon the death of Executive.
The Company’s total liability in such event shall be limited to payment of Executive’s salary and
benefits through the date of Executive’s death.
C. By Disability. The Company may terminate the Executive upon the inability of Executive to
perform on a full-time basis the duties and responsibilities of his employment with the Company by
reason of his illness or other physical or mental impairment or condition, if such inability
continues for an uninterrupted period of 90 days. A period of inability shall be “uninterrupted”
unless and until Executive returns to full-time work for a continuous period of at least 30 days.
The Company shall have no liability for severance pay or benefits following the date of Executive’s
termination of employment.
D. For Cause. The employment relationship between Executive and the Company created hereunder
shall automatically and immediately terminate upon the occurrence of any one of the following
events:
(i) the conviction of Executive of a felony;
(ii) the gross negligence or willful misconduct of Executive which is reasonably determined by
the Board to be injurious to the business or interests of the Company;
(iii) Executive’s willful violation of specific and lawful directions of the Board, which
persists for a period of 5 days after notice is given of such willful violation;
(iv) excessive absenteeism of Executive which persists for a period of 30 days after the Board
has given the Executive notice of such absenteeism;
(v) material failure of Executive to perform or observe the provisions of this Agreement with
the Company which persists for a period of 30 days after notice is given of such failure to perform
or observe; or
(vi) any act of fraud with respect to any aspect of the Company’s business where such act is
reasonably determined by the Board to be injurious to the business of the Company.
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E. Good Reason. Executive’s voluntary resignation of his employment under this Agreement will
be considered to be with “Good Reason” if, following the occurrence of one or more of the events
listed below, Executive (1) provides written notice to the Board of the event(s) constituting Good
Reason within thirty (30) days after the first occurrence of such event(s), (2) the Board a fails
to reasonably cure such event(s) within thirty (30) days after receiving such notice, and (3)
Executive’s termination of his employment is effective not later than thirty (30) days after the
end of the period in which the Board may cure the event(s). The following events will give rise to
Good Reason, unless Executive has consented thereto in writing:
(i) A permanent material reduction or diminution in the Executive’s job responsibilities or
duties; provided, however, that neither a mere change in title alone nor reassignment to a position
that is substantially similar to the position held prior to the reassignment shall constitute Good
Reason;
(ii) A material reduction by the Company of Executive’s Base Salary as in effect on the date
of this Agreement (as set forth on Schedule 2 hereof) or as same may be increased from time to time
thereafter; provided, however, that a general reduction of the base salary of all executive
employees of the Company shall not constitute Good Reason; or
(iii) The relocation of Executive, on a permanent basis, to an office that is more than
seventy-five (75) miles from the Minneapolis/St. Xxxx, Minnesota metropolitan area (unless such
relocation does not materially increase Executive’s average round trip commuting time).
9. Severance.
A. If the Company voluntarily terminates Executive’s employment without cause (and other than
as a result of Executive’s death or disability) or if Executive resigns his employment with Good
Reason, then subject to the effectiveness of Executive’s executed general waiver and release of
claims in favor of the Company and its affiliates (in substantially the form attached hereto as
Schedule 4), and provided Executive complies with his continuing obligations to the Company,
Executive shall be entitled to receive (i) a lump sum payment equal to six (6) months of his Base
Salary, less applicable withholdings and (ii) if Executive was enrolled in a group health plan
(e.g., medical, dental, or vision plan) sponsored by the Company immediately prior to termination,
and Executive elects to continue coverage under the Consolidated Omnibus Budget Reconciliation Act
of 1985 (together with any state law of similar effect, “COBRA”), the Company will pay the full
amount of the premiums due for Executive and his eligible dependents for the first six (6) months
of coverage under COBRA (or until such earlier time as Executive and/or his eligible dependents are
no longer eligible for COBRA coverage). Executive must execute the release of claims with in
forty-five (45) days following the date of termination, and allow the release to become effective
in accordance with its terms. If the release becomes effective within such time period, then the
all three of the lump sum payments shall be paid on the first regular payroll pay date following
the effective date of the release.
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B. If the Company (or, if applicable, the successor entity thereto) determines that these
severance payments and benefits (the “Payments”) constitute “deferred compensation” under Section
409A of the Internal Revenue Code (together, with any state law of similar effect, “Section 409A”)
and Executive is a “specified employee” of the Company or any successor entity thereto, as such
term is defined in Section 409A(a)(2)(B)(i) (a “Specified Employee”), then, solely to the extent
necessary to avoid the incurrence of the adverse personal tax consequences under Section 409A, the
timing of the Payments shall be delayed as follows: on the earliest to occur of (i) the date that
is six months and one day after the termination date, (ii) the date of the Eligible Employee’s
death, or (iii) such earlier date, as reasonably determined in good faith by the Company (or any
successor entity thereto), as would not result in any of the Payments being subject to adverse
personal tax consequences under Section 409A (such earliest date, the “Delayed Initial Payment
Date”), the Company (or the successor entity thereto, as applicable) shall (A) pay to Executive a
lump sum amount equal to the sum of the Payments that Executive would otherwise have received
through the Delayed Initial Payment Date if the commencement of the payment of the Payments had not
been delayed pursuant to this Section 9(B) and (B) commence paying the balance of the Payments in
accordance with the applicable payment schedules set forth in Section 9(A) above. For the
avoidance of doubt, it is intended that (1) each installment of the Payments provided in Section
9(A) above is a separate “payment” for purposes of Section 409A, (2) all Payments satisfy, to the
greatest extent possible, the exemptions from the application of Section 409A provided under of
Treasury Regulation 1.409A-1(b)(4) and 1.409A-1(b)(9)(iii), and (3) the Payments consisting of
COBRA premiums also satisfy, to the greatest extent possible, the exemptions from the application
of Section 409A provided under Treasury Regulation 1.409A-1(b)(9)(v).
10. Remedies. Each of the parties to this Agreement will be entitled to enforce its rights
under this Agreement specifically, to recover damages by reason of any breach of any provision of
this Agreement and to exercise all other rights existing in its favor. The parties hereto agree
and acknowledge that money damages may not be an adequate remedy for any breach of the provisions
of this Agreement and that any party may in its sole discretion apply to any court of law or equity
of competent jurisdiction in accordance with Section 16 for injunctive relief in order to enforce
or prevent any violations of the provisions of this Agreement.
11. Attorney Fees. If any arbitration proceeding or action at law or in equity, including any
action for declaratory or injunctive relief, is brought which arises out of this Agreement or the
termination of Executive’s employment, or which seeks to enforce or interpret this Agreement or to
seek damages for its breach, the prevailing party shall be entitled to recover reasonable attorney
fees from the non-prevailing party, which fees may be set by the court or arbitrator in the trial
of such action, or may be enforced in a separate action brought for that purpose, and which fees
shall be in addition to any other relief which may be awarded.
12. Assignment. This Agreement is personal to Executive and may not be assigned in any way by
Executive without the prior written consent of the Company. This Agreement shall not be assignable
or delegable by the Company. Any attempted assignment by Executive or the Company shall be void.
Notwithstanding the preceding two sentences, this Agreement may be assigned or delegated by the
Company to any parent company, subsidiary, successor or affiliate (where such affiliate is at least
51% owned by the Company) of the Company. The rights and obligations under this Agreement shall
inure to the benefit of and shall be binding
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upon the heirs, legatees, administrators and personal representatives of Executive and upon
the successors, affiliates, representatives and assigns of the Company.
13. Severability and Reformation. The parties hereto intend all provisions of this Agreement
to be enforced to the fullest extent permitted by law, and are intended to be limited to the extent
necessary so that they will not render this Agreement illegal, invalid, or unenforceable under
present or future law. If any provision of this Agreement or any application thereof shall be held
to be invalid, illegal or unenforceable, the validity, legality and enforceability of such
provision shall be fully severable, and this Agreement shall be construed and enforced as if such
illegal, invalid, or unenforceable provision were never a part hereof and the remaining provisions
shall remain in full force and effect and shall not be affected by the illegal, invalid, or
unenforceable provision or by its severance.
14. Notices. All notices and other communications required or permitted to be given hereunder
shall be in writing and shall be deemed to have been duly given if delivered personally, mailed by
certified mail (return receipt requested) or sent by overnight delivery service, cable, telegram,
facsimile transmission or telex to the parties at the following addresses or at such other
addresses as shall be specified by the parties by like notice:
If to the Company:
0000 Xxxxxxx Xxxx
Xxxx Xxxxxxx, XX 00000
Xxxx Xxxxxxx, XX 00000
Attention: Chief Executive Officer
If to the Executive:
Xxxxxxxx X. Xxxxxxx
c/o Compellent Technologies, Inc.
0000 Xxxxxxx Xxxx
Xxxx Xxxxxxx, XX 00000
c/o Compellent Technologies, Inc.
0000 Xxxxxxx Xxxx
Xxxx Xxxxxxx, XX 00000
Notice so given shall, in the case of notice so given by mail, be deemed to be given and received
on the fourth calendar day after posting, in the case of notice so given by overnight delivery
service, on the date of actual delivery and, in the case of notice so given by cable, telegram,
facsimile transmission, telex or personal delivery, on the date of actual transmission or, as the
case may be, personal delivery.
15. Further Actions. Whether or not specifically required under the terms of this Agreement,
each party hereto shall execute and deliver such documents and take such further actions as shall
be necessary in order for such party to perform al] of his or its obligations specified herein or
reasonably implied from the terms hereof.
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16. Governing Law and Venue. This Agreement is to be governed by and construed in accordance
with the laws of the State of Minnesota without giving effect to any choice or conflict of law
provision or rule that would cause the application of laws of any jurisdiction other than the state
of Minnesota. The parties agree that any dispute concerning this Agreement is to be brought in the
District Court in Hennepin County, Minnesota and consent to jurisdiction and venue therein.
17. Indemnification. Executive shall be indemnified by the Company in accordance with, and to
the fullest extent permitted by, the provisions of the Delaware General Corporation Act, as it may
be amended from time to time.
18. Entire Agreement and Amendment. This Agreement contains the entire understanding and
agreement between the parties, except as otherwise specified herein, and supersedes any other
agreement between Executive and the Company, whether oral or in writing, with respect to the
subject matter hereof. This Agreement may not be altered or amended, nor may any of its provisions
be waived, except by a writing signed by both parties hereto or, in the case of an asserted waiver,
by the party against whom the waiver is sought to be enforced.
19. No Waiver. No term or condition of this Agreement shall be deemed to have been waived,
except by a statement in writing signed by the party against whom enforcement of the waiver is
sought. Any written waiver shall not be deemed a continuing waiver unless specifically stated,
shall operate only as to the specific term or condition waived, and shall not constitute a waiver
of such term or condition for the future or as to any act other than that specifically waived.
20. Counterparts. This Agreement may be executed in counterparts, with the same effect as if
both parties had signed the same document. All such counterparts shall be deemed an original,
shall be construed together and shall constitute one and the same instrument.
[signature page follows]
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In Witness Whereof, the parties have executed this Agreement as of the date first
above written.
| THE COMPANY: | ||||
| Compellent Technologies, Inc. | ||||
By
|
/s/ Xxxxxx X. Xxxxx | |||
| Its President and Chief Executive Officer | ||||
| EXECUTIVE: | ||||
| /s/ Xxxxxxxx X. Xxxxxxx | ||||
| Xxxxxxxx X. Xxxxxxx | ||||
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SCHEDULE 1
Position and Duties of Executive
Position:
Executive is employed in the following position with the Company: Chief Technology Officer.
Duties:
Executive shall have the following duties: Overall management of technology development.
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SCHEDULE 2
Compensation
Base Salary:
Executive shall receive an annual Base Salary of $230,000 for calendar year of 2007. Determination
of annual Base Salary beyond calendar year 2007 shall be made by mutual agreement of Executive and
the Company. The Base Salary shall be subject to all appropriate federal and state withholding
taxes and shall be payable on the Company’s regular payroll schedule, which currently is a
semi-monthly basis in twenty-four (24) equal installments per year.
Benefits:
Executive shall be eligible to participate in all benefit programs and plans that the Company
provides to its key management employees consistent with the policies and procedures of the
Company. Additionally, the Company shall provide an annual allowance of $1,000 for a medical
physical examination for Executive.
Bonus:
Executive shall be entitled to participate in a mutually agreed upon yearly Bonus Program, as in
effect from time to time, at the level determined by the Board.
Vacation:
Executive shall be entitled to accrue vacation days, in accordance with the
Company’s general vacation accrual policy, to be taken with due observance of the interests of the
Company. Upon termination of this Agreement during a calendar year, compensation for vacation not
used will be calculated and compensated for on a pro rata basis. Executive shall also be entitled
to such holidays as are typically observed by the Company.
Reimbursement of Expenses:
The Company recognizes that Executive may incur legitimate business expenses in the course of
rendering services to the Company. Accordingly, the Company shall reimburse Executive for
reasonable business expenses to the extent and on the terms provided in the Company’s policies,
provided, however, that Executive shall not be reimbursed for any such expense that is not
substantiated, to the Company’s reasonable satisfaction, by way of invoice or other pertinent
documentation or information.
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SCHEDULE 3
PROPRIETARY AGREEMENT
PROPRIETARY AGREEMENT
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SCHEDULE 4
RELEASE AGREEMENT
RELEASE AGREEMENT
I understand that this Release, together with the rights to severance payments and benefits
set forth in the employment agreement between the Company and me
dated August 16, 2007 (the
“Employment Agreement”) to which this Release is attached, constitutes the complete, final and
exclusive embodiment of the entire agreement between the Company, affiliates of the Company and me
with regard to the subject matter hereof. I am not relying on any promise or representation by the
Company that is not expressly stated therein. Certain capitalized terms used in this Release are
defined in the Employment Agreement.
I hereby confirm my obligations under my Proprietary Agreement with the Company.
Except as otherwise set forth in this Release, I hereby generally and completely release the
Company and its current and former directors, officers, employees, stockholders, shareholders,
partners, agents, attorneys, predecessors, successors, parent and subsidiary entities, insurers,
affiliates, and assigns (collectively, the “Released Parties”) from any and all claims,
liabilities and obligations, both known and unknown, that arise out of or are in any way related
to events, acts, conduct, or omissions occurring prior to my signing this Release (collectively,
the “Released Claims”). The Released Claims include, but are not limited to: (1) all claims
arising out of or in any way related to my employment with the Company or its affiliates, or the
termination of that employment; (2) all claims related to my compensation or benefits, including
salary, bonuses, commissions, vacation pay, expense reimbursements, severance pay, fringe
benefits, stock, stock options, or any other ownership interests in the Company or its affiliates;
(3) all claims for breach of contract, wrongful termination, and breach of the implied covenant of
good faith and fair dealing; (4) all tort claims, including claims for fraud, defamation,
emotional distress, and discharge in violation of public policy; and (5) all federal, state, and
local statutory claims, including claims for discrimination, harassment, retaliation, attorneys’
fees, or other claims arising under the federal Civil Rights Act of 1964 (as amended), the federal
Americans with Disabilities Act of 1990, the federal Age Discrimination in Employment Act of 1967
(as amended) (“ADEA”), the federal Employee Retirement Income Security Act of 1974 (as amended),
and the California Fair Employment and Housing Act (as amended). Notwithstanding the foregoing,
the following are not included in the Released Claims (the “Excluded Claims”): (1) any rights or
claims for indemnification I may have pursuant to any written indemnification agreement with the
Company to which I am a party, the charter, bylaws, or operating agreements of the Company, or
under applicable law; or (2) any rights which are not waivable as a matter of law. In addition,
nothing in this Release prevents me from filing, cooperating with, or participating in any
proceeding before the Equal Employment Opportunity Commission or the Department of Labor, except
that I hereby waive my right to any monetary benefits in connection with any such claim, charge or
proceeding. I hereby represent and warrant that, other than the Excluded Claims, I am not aware
of any claims I have or might have against any of the Released Parties that are not included in
the Released Claims.
I acknowledge that I am knowingly and voluntarily waiving and releasing any rights I may have
under the ADEA. I also acknowledge that the consideration given for the Released
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Claims is in addition to anything of value to which I was already entitled. I further
acknowledge that I have been advised by this writing, as required by the ADEA, that: (a) the
Released Claims do not apply to any rights or claims that arise after the date I sign this Release;
(b) I should consult with an attorney prior to signing this Release (although I may choose
voluntarily not to do so); (c) I have twenty-one (21) days to consider this Release (although I may
choose to voluntarily to sign it sooner); (d) I have seven (7) days following the date I sign this
Release to revoke the Release by providing written notice to an officer of the Company; and (e) the
Release will not be effective until the date upon which the revocation period has expired
unexercised, which will be the eighth day after I sign this Release (“Effective Date”).
I acknowledge that I have read and understand Section 1542 of the California Civil Code which
reads as follows: “A general release does not extend to claims which the creditor does not know or
suspect to exist in his or her favor at the time of executing the release, which if known by him or
her must have materially affected his or her settlement with the debtor.” I hereby expressly waive
and relinquish all rights and benefits under that section and any law of any jurisdiction of
similar effect with respect to my release of any claims hereunder.
I hereby represent that I have been paid all compensation owed and for all hours worked, I
have received all the leave and leave benefits and protections for which I am eligible, and I have
not suffered any on-the-job injury for which I have not already filed a workers’ compensation
claim.
I acknowledge that to become effective, I must sign and return this Release to the Company so
that it is received not later than twenty-one (21) days following the date it is provided to me,
and I must not revoke it thereafter.
| Employee | ||||||
| Name: | ||||||
| Date: | ||||||
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