<SEC-DOCUMENT>0001026655-19-000033.txt : 20190520
<SEC-HEADER>0001026655-19-000033.hdr.sgml : 20190520
<ACCEPTANCE-DATETIME>20190520165905
ACCESSION NUMBER:		0001026655-19-000033
CONFORMED SUBMISSION TYPE:	8-K
PUBLIC DOCUMENT COUNT:		2
CONFORMED PERIOD OF REPORT:	20190516
ITEM INFORMATION:		Departure of Directors or Certain Officers; Election of Directors; Appointment of Certain Officers: Compensatory Arrangements of Certain Officers
ITEM INFORMATION:		Financial Statements and Exhibits
FILED AS OF DATE:		20190520
DATE AS OF CHANGE:		20190520

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			CORE MOLDING TECHNOLOGIES INC
		CENTRAL INDEX KEY:			0001026655
		STANDARD INDUSTRIAL CLASSIFICATION:	PLASTICS PRODUCTS, NEC [3089]
		IRS NUMBER:				311481870
		STATE OF INCORPORATION:			DE
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		8-K
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	001-12505
		FILM NUMBER:		19839497

	BUSINESS ADDRESS:	
		STREET 1:		800 MANOR PARK DRIVE
		STREET 2:		P O BOX 28183
		CITY:			COLUMBUS
		STATE:			OH
		ZIP:			43228
		BUSINESS PHONE:		8006666960

	MAIL ADDRESS:	
		STREET 1:		800 MANOR PARK DR
		STREET 2:		P O BOX 28183
		CITY:			COLUMBUS
		STATE:			OH
		ZIP:			43228

	FORMER COMPANY:	
		FORMER CONFORMED NAME:	CORE MATERIALS CORP
		DATE OF NAME CHANGE:	19961107
</SEC-HEADER>
<DOCUMENT>
<TYPE>8-K
<SEQUENCE>1
<FILENAME>a8-k2019saragreement.htm
<DESCRIPTION>8-K 2019 SAR AGREEMENT
<TEXT>
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<div><a name="sD8D66997AFF3576CB84C045D9C9D3924"></a></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;-sec-extract:summary;font-size:14pt;"><font style="font-family:inherit;font-size:14pt;">UNITED STATES</font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:14pt;"><font style="font-family:inherit;font-size:14pt;">SECURITIES AND EXCHANGE COMMISSION </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">WASHINGTON, D.C. 20549 </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:18pt;"><font style="font-family:inherit;font-size:18pt;">FORM 8-K </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">CURRENT REPORT </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 </font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:91.40625%;border-collapse:collapse;text-align:left;"><tr><td colspan="3"></td></tr><tr><td style="width:51%;"></td><td style="width:5%;"></td><td style="width:44%;"></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Date of Report (Date of Earliest Event Reported):</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">May 16, 2019</font></div></td></tr></table></div></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:24pt;"><font style="font-family:inherit;font-size:24pt;"><br></font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:24pt;"><font style="font-family:inherit;font-size:24pt;">CORE MOLDING TECHNOLOGIES, INC. </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">__________________________________________</font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">(Exact name of registrant as specified in its charter) </font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:94.140625%;border-collapse:collapse;text-align:left;"><tr><td colspan="3"></td></tr><tr><td style="width:35%;"></td><td style="width:33%;"></td><td style="width:32%;"></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Delaware</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">001-12505</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">31-1481870</font></div></td></tr><tr><td style="vertical-align:top;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="padding-bottom:6px;padding-top:6px;text-align:center;vertical-align:top;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;vertical-align:top;">_____________________</font></div><div style="padding-bottom:6px;padding-top:6px;text-align:center;vertical-align:top;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;vertical-align:top;">(State or other jurisdiction </font></div></td><td style="vertical-align:top;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="padding-bottom:6px;padding-top:6px;text-align:center;vertical-align:top;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;vertical-align:top;">_____________</font></div><div style="padding-bottom:6px;padding-top:6px;text-align:center;vertical-align:top;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;vertical-align:top;">(Commission </font></div></td><td style="vertical-align:top;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="padding-bottom:6px;padding-top:6px;text-align:center;vertical-align:top;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;vertical-align:top;">______________</font></div><div style="padding-bottom:6px;padding-top:6px;text-align:center;vertical-align:top;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;vertical-align:top;">(I.R.S. Employer </font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">of incorporation)</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">File Number)</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Identification No.)</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:14px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:14px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:14px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">800 Manor Park Drive, Columbus, Ohio</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">43228-0183</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">________________________________</font></div><div style="padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">(Address of principal executive offices) </font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">___________</font></div><div style="padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">(Zip Code) </font></div></td></tr></table></div></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:91.40625%;border-collapse:collapse;text-align:left;"><tr><td colspan="3"></td></tr><tr><td style="width:51%;"></td><td style="width:5%;"></td><td style="width:44%;"></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:21px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:21px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:21px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Registrant&#8217;s telephone number, including area code:</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">614-870-5000</font></div></td></tr></table></div></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Not Applicable </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">___________________________________________</font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Former name or former address, if changed since last report </font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions: </font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[ ] Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[ ] Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[ ] Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[ ] Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:justify;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (&#167;&#8201;230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (&#167;&#8201;240.12b-2 of this chapter). </font></div><div style="line-height:120%;text-align:justify;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Emerging growth company &#9744;</font></div><div style="line-height:120%;text-align:justify;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:justify;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act &#9744;</font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">Item 5.02 Departure of Directors or Certain Officers; Election of Directors; Appointment of Certain Officers; Compensatory Arrangements of Certain Officers.</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">&#160;</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">On May 16, 2019, The Board approved a form of award for Stock Appreciation Rights ("SARs"), under its 2006 Long-Term Equity Incentive Plan, which is attached as Exhibit 10.1 to this Form 8-K.</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">Item 9.01 Financial Statements and Exhibits. </font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">(d) Exhibits</font></div><div style="line-height:120%;text-align:justify;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:100%;border-collapse:collapse;text-align:left;"><tr><td colspan="3"></td></tr><tr><td style="width:19%;"></td><td style="width:2%;"></td><td style="width:79%;"></td></tr><tr><td style="vertical-align:bottom;border-bottom:1px solid #000000;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">Exhibit Number</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;border-bottom:1px solid #000000;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">Description</font></div></td></tr><tr><td style="vertical-align:middle;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">10.1</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="font-size:10pt;"><a style="text-decoration:underline;color:#0000FF;-sec-extract:exhibit;" href="formofsaragreement.htm"><font style="font-family:inherit;font-size:10pt;">Form of Award for Stock Appreciation Rights</font></a></div></td></tr></table></div></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-weight:bold;">SIGNATURES </font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;padding-bottom:6px;padding-top:6px;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized. </font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:92.1875%;border-collapse:collapse;text-align:left;"><tr><td colspan="5"></td></tr><tr><td style="width:20%;"></td><td style="width:30%;"></td><td style="width:6%;"></td><td style="width:1%;"></td><td style="width:43%;"></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:20px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:20px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:20px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:20px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:20px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td colspan="3" style="vertical-align:middle;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">CORE MOLDING TECHNOLOGIES, INC.</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:right;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">May 20, 2019</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;">By:</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;border-bottom:1px solid #000000;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;">/s/ John P. Zimmer</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:10px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;">Name: John P. Zimmer</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;font-style:italic;">Title: Executive Vice President, Treasurer, Secretary and Chief Financial Officer</font></div></td></tr></table></div></div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div>	</body>
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<TYPE>EX-10.1
<SEQUENCE>2
<FILENAME>formofsaragreement.htm
<DESCRIPTION>EXHIBIT 10.1 FORM OF SAR AGREEMENT
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		<title>Exhibit</title>
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<div><a name="saeb844f5cafe4ceab79bf984626f53b8"></a></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;padding-bottom:16px;text-align:right;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">Exhibit 10.1</font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">CORE MOLDING TECHNOLOGIES, INC.</font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">STOCK APPRECIATION RIGHTS </font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;font-weight:bold;">AWARD AGREEMENT</font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">THIS STOCK APPRECIATION RIGHTS AWARD AGREEMENT (this &#8220;Award Agreement&#8221;), is made to be effective as of ______ (the &#8220;Grant Date&#8221;) by and between Core Molding Technologies, Inc., a Delaware corporation (the &#8220;Company&#8221;), and Executive, an employee of the Company (the &#8220;Employee&#8221;).</font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">W I T N E S S E T H</font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">WHEREAS, pursuant to ARTICLE SEVEN of the Company&#8217;s 2006 Long-Term Equity Incentive Plan, as amended from time-to-time (the &#8220;Plan&#8221;), the Company desires to make an Award of Freestanding Stock Appreciation Rights (the &#8220;SAR or Award&#8221;) to the Employee; and</font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">WHEREAS, Employee wishes to accept said Award; and</font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">WHEREAS, the parties hereto understand and agree that any terms used and not defined herein have the same meanings as in the Plan.</font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">NOW THEREFORE, in consideration of the mutual covenants hereinafter set forth and for other good and valuable consideration, the parties hereto agree as follows:</font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">1.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Grant of Award</font><font style="font-family:inherit;font-size:12pt;">.  Pursuant to ARTICLE SEVEN of the Plan and on the terms and conditions stated below, the Company hereby grants to the Employee an Award of ______ SAR shares with an exercise price of $xx.xx per share.  </font></div><div style="line-height:120%;text-align:justify;padding-left:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">2.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Provisions of Plan Controlling</font><font style="font-family:inherit;font-size:12pt;">.  The Employee specifically understands and agrees that the SARs granted under the Plan are being awarded to the Employee pursuant to the Plan, copies of which Plan the Employee acknowledges he has read, understands and by which he agrees to be bound. The provisions of the Plan are incorporated herein by reference. In the event of a conflict between the terms and conditions of the Plan and this Award Agreement, the provisions of the Plan will control. </font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">3.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Vesting of SARs</font><font style="font-family:inherit;font-size:12pt;">. </font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">a.</font><font style="font-family:inherit;font-size:12pt;">The SARs will vest in the ordinary course pursuant to paragraph 3(c) below.  Notwithstanding the foregoing, any unvested and unexercised SARs awarded to the Employee shall be immediately forfeited to the Company for no consideration in the event (i) Employee voluntarily terminates his or her employment with the Company or a Subsidiary, or (ii) Employee is terminated by the Company or a Subsidiary (with or without cause).</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">b.</font><font style="font-family:inherit;font-size:12pt;">The SARs awarded hereunder shall immediately vest in the Employee and no longer subject to a risk of forfeiture upon the occurrence of the earliest of the following events:</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:72px;text-align:justify;text-indent:24px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:48px;">i.</font><font style="font-family:inherit;font-size:12pt;">the date on which the Company undergoes a &#8220;Change in Control&#8221; as defined in the Plan;</font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;text-align:justify;padding-left:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:72px;text-align:justify;text-indent:24px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:48px;">ii.</font><font style="font-family:inherit;font-size:12pt;">the date on which the Employee dies or becomes Disabled (as that term is defined below); or</font></div><div style="line-height:120%;text-align:justify;padding-left:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:72px;text-align:justify;text-indent:24px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:48px;">iii.</font><font style="font-family:inherit;font-size:12pt;">the date of the Employee&#8217;s 65</font><font style="font-family:inherit;font-size:12pt;"><sup style="vertical-align:top;line-height:120%;font-size:8pt">th</sup></font><font style="font-family:inherit;font-size:12pt;">&#32;birthday.</font></div><div style="line-height:120%;text-align:justify;padding-left:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">c.</font><font style="font-family:inherit;font-size:12pt;">The SARs awarded hereunder shall vest in the Employee and shall no longer be subject to a risk of forfeiture pursuant to the following schedule:</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:93.359375%;border-collapse:collapse;text-align:left;"><tr><td colspan="2"></td></tr><tr><td style="width:50%;"></td><td style="width:50%;"></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">Vesting Date</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;text-decoration:underline;">Percent Vested</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Date </font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">33.33%</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Date</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">66.67%</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Date</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:center;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">100%</font></div></td></tr></table></div></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;padding-left:48px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">d.</font><font style="font-family:inherit;font-size:12pt;">For purposes of this Award Agreement, the Employee shall be deemed disabled if the Employee is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or can be expect to last for a continuous period of not less than 12 months. </font></div><div style="line-height:120%;text-align:justify;padding-left:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">4.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">No Rights as a Stockholder</font><font style="font-family:inherit;font-size:12pt;">. Employee shall have no rights as a stockholder with respect to the Common Stock related to the SARs awarded hereunder unless and until the SARs vest and are exercised by the issuance of such shares of Common Stock.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">5.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Additional SARs</font><font style="font-family:inherit;font-size:12pt;">. </font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">a.</font><font style="font-family:inherit;font-size:12pt;">If the Company shall pay a stock dividend or declare a stock split on or with respect to any of its Common Stock, or otherwise distribute securities of the Company to the holders of its Common Stock, the number of shares of stock or other securities of the Company issued with respect to the SARs then subject to the restrictions contained in this Award Agreement shall be added to the SARs subject to this Award Agreement. If the Company shall distribute to its stockholders shares of stock of another corporation, the shares of stock of such other corporation distributed with respect to the SARs then subject to the restrictions contained in this Award Agreement shall be added to the SARs subject to this Award Agreement.</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">b.</font><font style="font-family:inherit;font-size:12pt;">If the outstanding shares of Common Stock of the Company shall be subdivided into a greater number of shares or combined into a smaller number of shares, or in the event of a reclassification of the outstanding shares of Common Stock of the Company, or if the Company shall be a party to a merger, consolidation or capital reorganization, there shall be substituted for the SARs then subject to the restrictions contained in this Award Agreement such amount and kind of securities as are issued in such subdivision, combination, reclassification, merger, consolidation or capital reorganization in respect of the SARs subject to this Award Agreement.</font></div><div style="line-height:120%;text-align:justify;padding-left:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">6.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Exercise of SARs</font><font style="font-family:inherit;font-size:12pt;">.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">a.</font><font style="font-family:inherit;font-size:12pt;">That portion of the SARs that have vested pursuant to Section 3 hereof may be exercised in whole or in part during an open exercise window determined by the Company in accordance with its insider trading policy (an &#8220;Exercise Window&#8221;) by delivering a signed, written notice to the Company on the exercise form adopted by the Company from time to time and in accordance with such policies, procedures and </font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;padding-left:0px;text-align:justify;"><font style="font-family:inherit;font-size:12pt;">instructions as the Company may reasonably adopt from time to time.  The date for settlement and payment upon exercise of the SAR shall be the date determined by the Company in accordance with the Plan, provided that the Company receives the fully completed and signed exercise form during such Exercise Window.  </font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">b.</font><font style="font-family:inherit;font-size:12pt;">Subject to the limitations of the Plan, the exercise of a SAR shall entitle the Employee to receive payment from the Company (or an Affiliate) in an amount determined by multiplying:</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:72px;text-align:justify;text-indent:24px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:48px;">i.</font><font style="font-family:inherit;font-size:12pt;">The difference between the Fair Market Value of a share of Common Stock (a &#8220;Share&#8221;) on the date of exercise of the SAR over the exercise price of the SAR by, </font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;padding-left:96px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">(ii)</font><font style="font-family:inherit;font-size:10pt;">&#160;&#160;&#160;&#160;</font><font style="font-family:inherit;font-size:12pt;">The number of SARs being exercised.</font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">Such consideration shall be paid in Shares (valued at Fair Market Value on the effective date of the exercise of the SAR). Subject to applicable restrictions under the Plan, settlement and payment shall be made within sixty (60) days of the close of the Exercise Window; provided that if such sixty (60) day period begins in one calendar year and ends in another, the Employee shall have no right to designate the calendar year of payment.  No fractional Shares will be issuable upon the exercise of a SAR, and the Employee will receive cash in lieu of fractional Shares.</font></div><div style="line-height:120%;padding-left:48px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">c.</font><font style="font-family:inherit;font-size:12pt;">Upon a termination of employment, Employee&#8217;s vested SARs are exercisable pursuant to Section 6(a) above.  However, if Employee&#8217;s termination of employment occurs outside of an Exercise Window then Employee may exercise his vested SARs during the next Exercise Window following Employee&#8217;s termination of employment.  </font></div><div style="line-height:120%;text-align:justify;padding-left:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">7.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">No Obligation to Employ</font><font style="font-family:inherit;font-size:12pt;">. The Company is not obligated, by the Plan or this Award Agreement, to continue the Employee as an employee of the Company. Further, nothing in the Plan or this Award Agreement shall be construed to limit the discretion of the Company to terminate the Employee&#8217;s service at any time, with or without cause.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">8.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Investment Intent</font><font style="font-family:inherit;font-size:12pt;">. The Employee represents and warrants to the Company that the SARs are being acquired for the Employee&#8217;s own account, for investment, and not with a view to, or for sale in connection with, the distribution of any such SARs.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">9.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Notices</font><font style="font-family:inherit;font-size:12pt;">. Any notices required or permitted by the terms of this Award Agreement or the Plan shall be given by recognized courier service, facsimile, registered or certified mail, return receipt requested, addressed as follows:</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;padding-left:288px;text-indent:-192px;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:74.0234375%;border-collapse:collapse;text-align:left;"><tr><td colspan="2"></td></tr><tr><td style="width:37%;"></td><td style="width:63%;"></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">To the Company:</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Core Molding Technologies</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">800 Manor Park Drive</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Columbus, OH 43228</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Attn: Treasurer</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:13px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">To the Employee:</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[NAME]</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[ADDRESS]</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:18px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:18px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr></table></div></div><div style="line-height:120%;padding-bottom:16px;text-align:left;padding-left:288px;text-indent:-192px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">or to such other address or addresses of which notice in the same manner has previously been given. Any such notice shall be deemed to have been given upon the earlier of receipt, one business day following delivery to a recognized courier service, or three business days following mailing by registered or certified mail.</font></div><div style="line-height:120%;padding-left:48px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">10.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Governing Law</font><font style="font-family:inherit;font-size:12pt;">. This Award Agreement shall be construed and enforced in accordance with the law of the State of Delaware (without giving effect to the conflict of laws principles thereof) in all respects, including, without limitation, matters relating to the validity, construction, interpretation, administration, effect, enforcement, and remedies provisions of this Award Agreement, except to the extent preempted by applicable federal law.</font></div><div style="line-height:120%;text-align:justify;padding-left:48px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">11.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Withholding</font><font style="font-family:inherit;font-size:12pt;">. Prior to delivery of Shares to Employee upon the exercise of the SARs, Employee shall be required to make arrangements, satisfactory to the Company, for appropriate withholding for federal, state, and local tax purposes. Employee is permitted to satisfy any such tax withholding requirements, in whole or in part, by any of the following means, or by a combination of the following such means:</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">a.</font><font style="font-family:inherit;font-size:12pt;">tendering a cash payment; or</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">b.</font><font style="font-family:inherit;font-size:12pt;">authorizing the Company to withhold Shares otherwise issuable or deliverable to the Employee as a result of the exercise of the SARs; provided, however, that no Shares shall be withheld with a value exceeding the maximum amount of tax required to be withheld by law; or</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">12.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Benefit of Award Agreement</font><font style="font-family:inherit;font-size:12pt;">. Subject to the provisions of the Plan and the other provisions hereof, this Agreement shall be for the benefit of and shall be binding upon the heirs, executors, administrators, successors and assigns of the parties hereto.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">13.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Entire Award Agreement</font><font style="font-family:inherit;font-size:12pt;">. This Award Agreement, together with the Plan, embodies the entire agreement and understanding between the parties hereto with respect to the subject matter hereof and supersedes all prior oral or written agreements and understandings relating to the subject matter hereof. No statement, representation, warranty, covenant or agreement not expressly set forth in this Award Agreement shall affect or be used to interpret, change or restrict the express terms and provisions of this Award Agreement, provided, however, in any event, this Award Agreement shall be subject to and governed by the Plan.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">14.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Modifications and Amendments</font><font style="font-family:inherit;font-size:12pt;">. The terms and provisions of this Award Agreement may be modified or amended as provided in the Plan.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">15.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Waivers and Consents</font><font style="font-family:inherit;font-size:12pt;">. The terms and provisions of this Award Agreement may be waived, or consent for the departure therefrom granted, only by written document executed by the party entitled to the benefits of such terms or provisions. No such waiver or consent shall be deemed to be or shall constitute a waiver or consent with respect to any other terms or provisions of this Award Agreement, whether or not similar. Each such waiver or consent shall be effective only in the specific instance and for the purpose for which it was given, and shall not constitute a continuing waiver or consent.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">16.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Section 409A</font><font style="font-family:inherit;font-size:12pt;">.  This Award Agreement is intended to comply with Section 409A of the Code or an exemption thereunder and shall be construed and interpreted in a manner that is consistent with the requirements for avoiding additional taxes or penalties under Section 409A of the Code.  Notwithstanding the foregoing, the Company makes no representations that the payments and benefits provided under this Award Agreement comply with Section 409A of the Code and in no event shall the Company be liable for </font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;padding-left:0px;text-align:justify;"><font style="font-family:inherit;font-size:12pt;">all or any portion of any taxes, penalties, interest or other expenses that may be incurred by the Employee on account of non-compliance with Section 409A of the Code. </font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">17.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Severability</font><font style="font-family:inherit;font-size:12pt;">.  The invalidity or unenforceability of any provision of the Plan or this Award Agreement shall not affect the validity or enforceability of any other provision of the Plan or this Award Agreement, and each provision of the Plan and this Award Agreement shall be severable and enforceable to the extent permitted by law.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">18.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Counterparts</font><font style="font-family:inherit;font-size:12pt;">.  This Award Agreement may be executed in counterparts, each of which shall be deemed an original but all of which together will constitute one and the same instrument.  Counterpart signature pages to this Award Agreement transmitted by facsimile transmission, by electronic mail in portable document format (.pdf), or by any other electronic means intended to preserve the original graphic and pictorial appearance of a document, will have the same effect as physical delivery of the paper document bearing an original signature.</font></div><div style="line-height:120%;text-align:justify;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-left:0px;text-align:justify;text-indent:72px;"><font style="text-align:justify;font-family:inherit;font-size:10pt;padding-right:24px;">19.</font><font style="font-family:inherit;font-size:12pt;text-decoration:underline;">Acceptance</font><font style="font-family:inherit;font-size:12pt;">.  The Employee hereby acknowledges receipt of a copy of the Plan and this Award Agreement.  The Employee has read and understands the terms and provisions thereof, and accepts the SARs subject to all of the terms and conditions of the Plan and Award this Agreement.</font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:center;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">[</font><font style="font-family:inherit;font-size:12pt;font-style:italic;">Remainder of page intentionally left blank. Signature page follows</font><font style="font-family:inherit;font-size:12pt;">]</font></div><div style="line-height:120%;text-align:left;text-indent:48px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;&#160;&#160;&#160;</font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font 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style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;"><br></font></div><div><br></div><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><hr style="page-break-after:always"><div><div style="line-height:120%;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;"><br></font></div></div><div><br></div><div style="line-height:120%;padding-bottom:16px;text-align:justify;text-indent:72px;font-size:12pt;"><font style="font-family:inherit;font-size:12pt;">IN WITNESS WHEREOF, the Company has caused this Award Agreement to be executed by a duly authorized officer, and the Employee has hereunto set his or her hand, all as of the day and year first above written.</font></div><div style="line-height:120%;text-align:center;font-size:10pt;"><div style="padding-left:0px;text-indent:0px;line-height:normal;padding-top:10px;"><table cellpadding="0" cellspacing="0" style="font-family:Times New Roman;font-size:10pt;margin-left:auto;margin-right:auto;width:93.359375%;border-collapse:collapse;text-align:left;"><tr><td colspan="2"></td></tr><tr><td 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style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">By:</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Name:</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">Title:</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:53px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:53px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:53px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:53px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">[EMPLOYEE NAME]</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:53px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;height:53px;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td></tr><tr><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="overflow:hidden;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">&#160;</font></div></td><td style="vertical-align:bottom;padding-left:2px;padding-top:2px;padding-bottom:2px;padding-right:2px;"><div style="text-align:left;font-size:10pt;"><font style="font-family:inherit;font-size:10pt;">By:</font></div></td></tr><tr><td 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