Fill and Sign the Employer Severance Form

Accord and Satisfaction and Release between Employer and Executive Employee pursuant to Severance Agreement This Accord, Satisfaction and Release (this Release) is made this the       , (Date) hereinafter called the Effective Date, between       , a (Name of Employer) corporation organized and existing under the laws of the state of       , (Name of State) with its principal office located at       , (Street Address, City, County, State, Zip Code) referred to herein as the Employer, and       , of (Name of Executive)       , hereinafter called the Executive. (Street Address, City, County, State, Zip Code) 1. Release of Executive. In consideration of the promises, covenants and other valuable consideration provided by Employer in the Agreement, Executive assigns, unconditionally releases, satisfies and discharges Employer and the Subsidiaries (as defined in the Agreement), and its and their current and former employees, officers, agents and directors in their capacities as such (collectively, the Released Parties), from any and all claims, causes of action, demands, losses, obligations, liabilities, damages, judgments, costs, expenses (including attorney's fees) of any nature whatsoever, known or unknown, contingent or non-contingent (collectively, the Claims), that Executive had, has or will have arising from, or connected with, any act, omission, deed or event occurring up to the Effective Date, including but not limited to Claims:  Related to Executive's employment or other relationship with Employer and separation or termination of such employment or other relationship;  Under any federal or state law, including but not limited to Title VII of the Civil Rights Act of 1964, the Equal Pay Act, the Employee Retirement Income Security Act, the Consolidated Omnibus Budget Reconciliation Act, the National Labor Relations Act, the Occupational Safety and Health Act, the Fair Labor Standards Act, the Family and Medical Leave Act, the Workers Adjustment and Retraining Notification Act, the Americans with Disabilities Act, but excluding the Age Discrimination in Employment Act of 1967;  Under federal or state common law; and  Under any agreement, whether written or oral, including the Employment Agreement. However, Executive does not discharge or release: any Claims under the Agreement; Executive's right to indemnification or advancement of expenses under any agreement, Employer's articles of incorporation, charter or bylaws, any insurance policy or applicable law; or Claims against any Accord and Satisfaction and Release between Employer and Executive Employee Page 1 of 3 Released Party arising from events in which the Released Party was not acting as an employee, officer, agent or director of Employer or any Subsidiary. 2. No Claims against Released Parties. Executive warrants and represents that, to the full extent permitted by law, Executive has not and will not bring or assign any Claim or action against Employer or any of the Released Parties that is released by Executive under Section 1 of this Release. Executive agrees that if Executive brings or assigns any such Claim or action, Executive shall pay all costs and expenses, including reasonable attorney's fees, incurred by Employer or the Released Parties in dismissing or defending the action or lawsuit. Nothing in this provision, however, shall be interpreted to prevent Executive from bringing a Claim or action to enforce the terms of the Agreement or to bring a Claim or action which is not released under Section 1 of this Release. 3. Breach of this Release . If a court of competent jurisdiction determines that Executive has breached or failed to perform any part of this Release, Employer shall be entitled to injunctive relief to enforce this Release and Executive shall be responsible for paying Employer's costs and attorney's fees incurred in enforcing this Release. 4. This Release may be executed in multiple counterparts, whether or not all signatories appear on these counterparts, and each counterpart shall be deemed an original for all purposes. 5. BY SIGNING THIS RELEASE, EXECUTIVE ACKNOWLEDGES THAT HE HAS CAREFULLY READ THIS RELEASE, THAT HE UNDERSTANDS ALL OF ITS TERMS, AND THAT HE IS ENTERING INTO IT VOLUNTARILY. HE FURTHER ACKNOWLEDGES THAT HE IS AWARE OF HIS RIGHTS TO REVIEW AND CONSIDER THIS RELEASE WITH AN ATTORNEY AND THAT BEFORE SIGNING THIS RELEASE, HE HAS THOROUGHLY DISCUSSED ALL ASPECTS OF THIS RELEASE WITH COUNSEL OF HIS CHOOSING. HE ALSO ACKNOWLEDGES THAT HE WILL BE RECEIVING BENEFITS THAT HE WOULD NOT OTHERWISE BE ENTITLED TO RECEIVE EXCEPT BY VIRTUE OF HIS ENTERING INTO THIS RELEASE AND THE AGREEMENT. 6. Governing Law. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of       . (Name of State) 7. Entire Agreement. This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. WITNESS our signatures as of the day and date first above stated. Accord and Satisfaction and Release between Employer and Executive Employee Page 2 of 3       (Name of Employer) By: (Signature of Officer) (Signature of Employee)             (Print or Type Name) (Print or Type Name)       (Office in Corporation) Accord and Satisfaction and Release between Employer and Executive Employee Page 3 of 3