UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
______________________________________________________________________________________________________

FORM 8-K
______________________________________________________________________________________________________

CURRENT REPORT
Pursuant to Section 13 or 15(d) of the
Securities Exchange Act of 1934

Date of Report (Date of earliest event reported): March 3, 2017
______________________________________________________________________________________________________
FCSCLOGOCOLOR.JPG
FIBROCELL SCIENCE, INC.
(Exact Name of Registrant as Specified in its Charter)
______________________________________________________________________________________________________
DELAWARE
001-31564
87-0458888
(State or Other Jurisdiction of Incorporation or Organization)
(Commission File No.)
(I.R.S. Employer Identification No.)

405 EAGLEVIEW BLVD., EXTON, PA 19341
(Address of principal executive offices and zip code)

(484) 713-6000
(Registrant’s telephone number, including area code)
(Former name or former address, if changed from last report)
______________________________________________________________________________________________________
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 (see General Instruction A.2. below):
q
Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)
 
 
q
Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)
 
 
q
Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))
 
 
q
Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-14(c))






Item 5.02 Departure of Directors or Certain Officers; Election of Directors; Appointment of Certain Officers; Compensatory Arrangements of Certain Officers.

As previously disclosed, on February 10, 2017, Kimberly M. Smith tendered her resignation as Vice President of Corporate Accounting and Controller of the Company, effective as of March 10, 2017.

On March 3, 2017, Ms. Smith and the Company entered into a separation agreement and general release (the “Separation Agreement”), which sets forth the terms of Ms. Smith's separation. Pursuant to the Separation Agreement, the effective date of Ms. Smith’s resignation has been changed to March 31, 2017 (the “Termination Date”). Subject to Ms. Smith agreeing to a release of claims and complying with certain other continuing obligations contained therein, the Company shall continue to employ Ms. Smith through the Termination Date at her current full rate of pay and pay Ms. Smith the total amount of twenty-six thousand dollars ($26,000), less applicable withholdings and deductions. In addition, the Company will (a) pay any and all of Ms. Smith's compensation due and owing to her as of the Termination Date, including any accrued and unused vacation for fiscal year 2016 and 2017, in accordance with the Company’s usual compensation and payroll practices, and (b) reimburse Ms. Smith for all reasonable unreimbursed business expenses incurred by her as of the Termination Date in accordance with the Company’s expense reimbursement policy.

The foregoing description of the Separation Agreement does not purport to be complete, and is qualified in its entirety by reference to such agreement, filed as Exhibit 10.1 and incorporated herein by reference.


Item 9.01 Financial Statements and Exhibits.

(d)    Exhibits

Exhibit No.
 
Description
 
 
 
10.1
 
Separation Agreement and General Release, dated March 3, 2017, by and between Fibrocell Science, Inc. and Kimberly M. Smith






SIGNATURES
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.
 
 
 
 
 
 
Fibrocell Science, Inc.
By:
 
/s/ John M. Maslowski
 
 
John M. Maslowski
 
 
Chief Executive Officer
Date: March 3, 2017






EXHIBIT INDEX
 
Exhibit No.
 
Description
 
 
 
10.1
 
Separation Agreement and General Release, dated March 3, 2017, by and between Fibrocell Science, Inc. and Kimberly M. Smith






Exhibit 10.1

SEPARATION AGREEMENT AND GENERAL RELEASE
NOTICE: YOU SHOULD THOROUGHLY REVIEW AND UNDERSTAND THE TERMS, CONDITIONS, AND EFFECT OF THIS SEPARATION AGREEMENT AND GENERAL RELEASE. YOU ARE ADVISED TO CONSULT WITH AN ATTORNEY BEFORE SIGNING IT.
The parties to this Separation Agreement and General Release (hereinafter “Agreement”) are Fibrocell Science, Inc. (the “Company”) and Kimberly M. Smith (“Employee”) (collectively, “Parties”).
WHEREAS , Employee tendered her resignation as Vice President of Corporate Accounting and Controller of the Company, effective as of March 31, 2017 (the “Termination Date”); and
WHEREAS , the Company and Employee desire to set forth their agreement concerning the terms and conditions of the cessation of employment of Employee, including the precise nature and amount of compensation to be provided to Employee and any other rights and obligations of the Company and Employee following Employee’s resignation;
NOW, THEREFORE , in consideration of the respective promises set forth herein, which the Parties acknowledge are adequate consideration for the promises made herein, and subject to the conditions described herein, the Parties acknowledge and agree as follows:
1 .      Termination Date : Employee’s employment with the Company shall end on the Termination Date. The Company shall pay any and all of Employee’s compensation due and owing as of the Termination Date, including Employee’s accrued but unused vacation for fiscal year 2016 (24 hours) and for fiscal year 2017 any accrued but unused vacation up to and including the Termination Date, in accordance with the Company’s usual compensation and payroll practices. Employee shall be entitled to reimbursement of all reasonable unreimbursed business expenses incurred as of the Termination Date in accordance with Company’s expense reimbursement policy. Except as specifically provided by this Agreement, the Company shall have no other obligations or liabilities to Employee following the Termination Date.
2.     Employment Through Separation Date : As consideration for Employee signing this Agreement no later than 21 days from the date on which Employee receives it, not revoking it during the first Revocation Period (defined below), and abiding by this Agreement’s terms, the Company shall continue to employ Employee through the Termination Date and, beginning on March 10, 2017, shall permit Employee to work a reduced schedule of at least 20 hours per week, but no more than 30 hours per week, at her current full rate of pay.
3.     Severance Payment : As consideration for Employee signing this Agreement on the Termination Date, not revoking it and complying with its terms, the Company shall pay Employee the total amount of twenty-six thousand dollars ($26,000) (the “Severance Payment Amount”). The Company shall pay the Severance Payment Amount to Employee, less applicable withholdings and deductions, on the Company’s next regular payday following the expiration of the second Revocation Period (defined herein). The Parties agree that the Severance Payment Amount is contingent on Employee continuing to remain employed by the Company and performing her duties through the Termination Date (subject to the reduced work schedule set forth in Section 2 hereof). The treatment of any outstanding stock options held by the Employee on the Termination Date shall be determined in accordance with the terms of the Company’s 2009 Equity Incentive Plan and the applicable award agreements.

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Exhibit 10.1

4.     Release : Employee, for herself, her attorney, heirs, executors and assigns, does hereby fully and forever release and discharge the Company and its past, current and future subsidiaries and affiliates, as well as their predecessors, successors, assigns, and all of their past, current and former directors, officers, partners, agents, employees, attorneys, and administrators (collectively, the “Company Released Parties”) from all suits, causes of action, and/or claims, demands or entitlements of any nature whatsoever, whether known, unknown, or unforeseen, which Employee has or may have against any of them arising out of or in connection with her employment by the Company, the termination of Employee’s employment with the Company, or any event, transaction, or matter occurring or existing on or before the date of Employee’s signing of this Agreement related to the Company, except that Employee is not releasing (i) Employee’s continuing rights to indemnification and coverage under the Company’s current and future director and officer insurance policies to the same extent as the directors and officers of the Company are covered under such policies, which rights shall survive the Employee’s termination of employment, in accordance with the terms of such policies; (ii) any other right to indemnification or insurance coverage that Employee may have under the Company’s insurance policies, certificate of incorporation, bylaws or otherwise; (iii) any claims relating to any rights Employee may have pursuant to stock option awards granted to Employee by the Company (collectively, the “Stock Option Awards”) that vested before the Termination Date; or (iv) any claims arising after the date of Employee signing this Agreement. Employee shall not file or otherwise institute any claim, demand or lawsuit seeking damages or other relief and not to otherwise assert any claims, demands or entitlements that are released herein. Employee further hereby irrevocably and unconditionally waives any and all rights to recover any relief or damages concerning the claims, demands or entitlements that are released herein. Employee represents and warrants that Employee has not previously filed or joined in any such claims, demands or entitlements against the Company or the other persons or entities released herein and that Employee will indemnify and hold them harmless from all liabilities, claims, demands, costs, expenses and/or attorney’s fees incurred as a result of any such claims, demands or lawsuits.
This Agreement specifically includes, but is not limited to, all claims of breach of contract, employment discrimination (including any claims coming within the scope of Title VII of the Civil Rights Act, the Age Discrimination in Employment Act (“ADEA”), the Older Workers Benefit Protection Act, the Equal Pay Act, the Americans with Disabilities Act, and the Family and Medical Leave Act, all as amended, or any other applicable federal, state, or local law), claims under the Worker Adjustment and Retraining Notification Act, claims under the Sarbanes-Oxley Act of 2002, including the Corporate and Criminal Fraud Accountability Act, claims under the Employee Retirement Income Security Act, as amended, claims under the Fair Labor Standards Act, as amended (or any other applicable federal, state or local statute relating to payment of wages), claims for wrongful discharge in violation of public policy, claims under the Employment Discrimination Bureau (EDB) - Pennsylvania, the Pennsylvania Family Leave Act, the Pennsylvania Workers’ Compensation Act, the Pennsylvania State Wage and Hour Law, the Pennsylvania Law on Equal Pay, the Pennsylvania Political Activities of Employees Law, the Pennsylvania Lie Detector Testing Law, the Pennsylvania Tobacco Use Law, the Pennsylvania Genetic Testing Law, the State of Pennsylvania Labor Relations Act, the Pennsylvania Human Rights Law, and the Pennsylvania Labor Law, claims for discrimination in violation of the Pennsylvania Human Relations Act, claims for breach of express or implied contract, wage orders, claims concerning recruitment, hiring, termination, salary rate, severance pay, wages or benefits due, sick leave, holiday pay, vacation pay, life insurance, group medical insurance, any other fringe benefits, worker’s compensation, termination, employment status, libel, slander, defamation, intentional or negligent misrepresentation and/or infliction of emotional distress, together with any and all tort, contract, or other claims which might have been asserted by Employee or on her behalf in any suit, charge of discrimination, or claim against the Company or the persons or entities released herein.
Employee acknowledges that different or additional facts may be discovered in addition to what Employee now knows or believes to be true with respect to the matters released in this Agreement, and this

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Exhibit 10.1

Agreement shall be and remain in effect in all respects as a complete and final release of the matters released, notwithstanding any different or additional facts.
However, notwithstanding the foregoing, nothing in this Agreement shall be construed to waive any right that is not subject to waiver by private agreement, including, without limitation, any claims arising under state unemployment insurance or workers compensation laws.  Likewise, nothing in this Agreement shall be construed to prohibit Employee from filing a charge with or participating in any investigation or proceeding conducted by the EEOC, NLRB, or any comparable state or local agency.  Notwithstanding the foregoing, Employee agrees to waive her right to recover individual relief from the Company Released Parties in any charge, complaint, or lawsuit filed by Employee or anyone on her behalf.
5.     Non-admission of Liability or Wrongdoing : The Parties understand and agree that the execution of this Agreement does not constitute an admission by any party of any liability or wrongdoing on the part of that party.
6.     Restricted Information : Employee shall not disclose to anyone outside of the Company, or use for Employee’s own benefit or the benefit of anyone other than the Company, any nonpublic information regarding the Company’s business, including but not limited to: (a) customer information, such as the Company’s customer list and other nonpublic information regarding the Company’s customers, such as customer contact information; contract terms; customer files; information regarding customer history, needs and preferences; and information designated by customers to be kept confidential; (b) financial information, such as sales plans and forecasts; sales and earnings figures; cost and profitability information; and pricing; (c) corporate strategies, marketing and other strategic plans; (d) technical and product information, such as sources of supply; manufacturing methods; product development plans; product testing plans, protocols, data and results; and intellectual property; and (e) personnel files and information (collectively, the “Restricted Information”). Restricted Information does not include any information that is, or becomes, in the public domain through no disclosure or other action (whether direct or indirect) by Employee. The obligations in this Section 6 with respect to a particular piece of Restricted Information shall remain in effect until that piece of information enters the public domain through no breach of contract or duty by Employee. Pursuant to 18 USC § 1833(b), Employee agrees and understands that an individual may not be held liable under any criminal or civil federal or state trade secret law for disclosure of a trade secret: (i) made in confidence to a government official, either directly or indirectly, or to an attorney, solely for the purpose of reporting or investigating a suspected violation of law or (ii) in a complaint or other document filed in a lawsuit or other proceeding, if such filing is made under seal. Additionally, an individual suing an entity for retaliation based on the reporting of a suspected violation of law may disclose a trade secret to his or her attorney and use the trade secret information in the court proceeding, so long as any document containing the trade secret is filed under seal and the individual does not disclose the trade secret except pursuant to court order. Nothing in this Agreement is intended to conflict with 18 USC § 1833(b) or create liability for disclosures of trade secrets that are expressly allowed by 18 USC § 1833(b).
7.     Non-Disparagement : Employee shall not make any written or oral statement that may defame, disparage or cast in a negative light so as to do harm to the personal or professional reputation of (a) the Company and its subsidiaries and affiliates, (b) their employees, officers, directors or trustees or (c) the services and/or products being developed or provided by the Company or its subsidiaries or affiliates. The Company, including its Director of Human Resources, Section 16 officers and members of its Board of Directors shall not make any written or oral statement that may defame, disparage or cast in a negative light so as to do harm to the personal or professional reputation of Employee.
8.     Cooperation : Employee shall cooperate with the Company and its subsidiaries or affiliates in connection with any pending or future investigation, litigation, proceeding or other matter which may be filed

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Exhibit 10.1

against or by the Company or its subsidiaries or affiliates with any agency, court, or other tribunal and concerning or relating to any matter falling within Employee’s knowledge or former area of responsibility. Employee shall provide reasonable assistance and completely truthful testimony in such matters as needed. The Company shall compensate the Employee for services performed by Employee pursuant to this Section 8 at $200 per hour and shall reimburse Employee for all reasonable associated out of pocket expenses incurred at the request of the Company.
9.     Consulting Agreement : The Company also agrees, conditioned on Employee’s double execution of, non-revocation of and compliance with this Agreement, to compensate Employee at a rate of $200 per hour for any consulting services Employee provides to the Company, upon the Company’s request, after the Termination Date, subject to the parties mutually agreeing to additional terms regarding such consulting arrangement.
10.     Return of Property; Deductions : Promptly after the Termination Date, Employee shall return the original and all copies of Company property, including but not limited to any and all Restricted Information and all documents, files, manuals, forms, records, contact information or lists, financial information, drawings, plans, hardware, software, access codes, keys, credit cards, and any and all other physical, intellectual, or personal property of the Company or its subsidiaries or affiliates. Employee hereby authorizes the Company to deduct as an offset from the above-referenced Special Payment Amount the value of any Company property not returned or returned in a damaged condition as well as any monies paid by the Company on Employee’s behalf, unless prohibited by applicable law. Employee further represents that Employee has not retained any non-public information about the Company or its affiliates or subsidiaries on any personal computer or portable data storage device or in any other manner.
11.     Breach : In the event that Employee or the Company breaches or threatens to breach any provision of this Agreement, Employee or the Company, as applicable, shall be entitled to seek any and all equitable and legal relief provided by law, specifically including immediate and permanent injunctive relief. Employee and the Company hereby waive any claim that the other Party has as an adequate remedy at law. In addition, and to the extent not prohibited by law, Employee and the Company, as applicable, shall be entitled to an award of all costs and attorneys’ fees incurred by either Party in any successful effort to enforce the terms of this Agreement. The foregoing relief shall not be construed to limit or otherwise restrict either Party’s ability to pursue any other remedy provided by law, including the recovery of any actual, compensatory or punitive damages.
12.     Communication with Government Agencies : Notwithstanding anything to the contrary herein, Employee understands that nothing in this Agreement restricts or prohibits Employee from initiating communications directly with, responding to any inquiries from, providing testimony before, providing confidential information to, reporting possible violations of law or regulation to, or from filing a claim or assisting with an investigation directly with a self-regulatory authority or a government agency or entity (collectively, “Government Agencies”), or from making other disclosures that are protected under the whistleblower provisions of state or federal law or regulation, and Employee does not need the Company’s prior authorization to engage in such conduct. This Agreement does not limit Employee’s right to receive an award for information provided to Government Agencies.
13.     Section 409A : This Agreement is intended to comply with Section 409A of the Internal Revenue Code of 1986, as amended (“Section 409A”) or an exemption thereunder and shall be construed and administered in accordance with Section 409A. Notwithstanding any other provision of this Agreement, payments provided under this Agreement may only be made upon an event and in a manner that complies with Section 409A or an applicable exemption. Any payments under this Agreement that may be excluded from Section 409A either as separation pay due to an involuntary separation from service or as a short-term deferral shall be excluded from

4


Exhibit 10.1

Section 409A to the maximum extent possible. Any payments to be made under this Agreement upon a termination of employment shall only be made upon a “separation from service” under Section 409A and any payments to be made under this Agreement that are subject to Section 409A and that are payable to a “specified employee” on account of “separation from service” (other than amounts exempt from Section 409A) during the first six (6) months after the date of Employee’s “separation from service,” shall be paid on the first day of the seventh month beginning after the date of Employee’s “separation from service” (or upon Employee’s death, if earlier). Notwithstanding the foregoing, the Company makes no representations that the payments provided under this Agreement comply with Section 409A and in no event shall the Company be liable for all or any portion of any taxes, penalties, interest or other expenses that may be incurred by Employee on account of non-compliance with Section 409A.
14.     Arbitration of Disputes : Any dispute, controversy or claim arising out of or related to Employee’s employment with the Company, this Agreement or any breach of this Agreement shall be submitted to and decided by binding arbitration in the County of Chester, Pennsylvania. Arbitration shall be administered exclusively by the American Arbitration Association and shall be conducted consistent with the rules, regulations and requirements thereof as well as any requirements imposed by state law. Any arbitral award determination shall be final and binding upon the Parties.
15.     Acknowledgements by Employee : In signing this Agreement, Employee acknowledges:
(1)
That she has not suffered any job-related wrongs or injuries, such as any type of discrimination, for which she might still be entitled to compensation or relief in the future. Except as otherwise set forth herein, Employee has been paid all wages, compensation and benefits, and other amounts that the Company or any Company Released Party should have paid her in the past.
(2)
That she is not aware of any unlawful conduct by the Company or any of its directors, officers or employees.
(3)
That she is intentionally releasing claims that she did not know that she might have and that, with hindsight, she might regret having released. Employee has not assigned or given away any of the claims she is releasing.
(4)
That she has read and understands this Agreement and that she has been advised to consult with an attorney about its meaning and effect and has done so.
(5)
That she is receiving monies or other consideration to which she is not otherwise entitled by signing the Agreement and that she is releasing all claims against the Company Released Parties, whether known or unknown, knowingly and voluntarily and without duress, coercion or undue influence of any kind.
16.     Knowing and Voluntary Execution : Employee states and represents that she has carefully read this Agreement and knows and understands the contents thereof, and that she has executed the same as her own free act and deed. Employee also acknowledges that she has had the opportunity to ask questions about each and every provision of this Agreement and that she fully understands the effect of the provisions contained herein upon her legal rights.
17.     Executed Counterparts : This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but all of which shall constitute one and the same instrument.

5


Exhibit 10.1

18.     Modification : No provision of this Agreement may be modified, waived or discharged unless such waiver, modification or discharge is agreed to in writing and signed by both Parties.
19.     Effect of Void Provision : If a Party successfully asserts that any provision in this Agreement is void or invalid, the rest of the Agreement shall remain valid and enforceable unless the other Party elects to cancel it. If this Agreement is cancelled by the Company or Employee successfully asserts that Sections 4, 5, 6, 7, 8, 10, 15, 16, 20 and 21 are void or invalid pursuant to the preceding sentence, then Employee will forfeit and/or repay any additional amounts which Employee received in exchange for signing it.
20.     Assignability : Employee’s obligations and agreements under this Agreement shall be binding on her heirs, executors, legal representatives and assigns and shall inure to the benefit of any successors and assigns of the Company. The Company may, at any time, assign this Agreement or any of its rights or obligations arising hereunder (other than its payment obligations) to any party. The Company’s obligations and agreements under this Agreement shall be binding on its successors and assigns and shall inure to the benefit of Employee’s heirs, successors and assigns.
21.     Entire Agreement : This Agreement sets forth the entire agreement between the Parties hereto and supersedes and replaces any and all prior or contemporaneous representations or agreements, whether oral or written, relating to the subject matter herein (specifically excluding, however, post-termination obligations contained in the Stock Option Awards, which shall remain in full force and effect). Each Party acknowledges that when they decided to sign this Agreement, they were not relying on any representations that are not in this Agreement. The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the Parties.
22.     Governing Law : This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania, without regard to its conflicts of law provisions.
YOU MAY NOT MAKE ANY CHANGES TO THE TERMS OF THIS AGREEMENT. BEFORE SIGNING THIS AGREEMENT, READ IT CAREFULLY, AND THE COMPANY ADVISES THAT YOU DISCUSS IT WITH YOUR ATTORNEY AT YOUR OWN EXPENSE. YOU ACKNOWLEDGE THAT FOR EACH OF YOUR SIGNATURES BELOW YOU HAVE HAD AT LEAST 21 CALENDAR DAYS FROM THE DATE YOU RECEIVED THIS AGREEMENT TO CONSIDER ITS TERMS BEFORE SIGNING IT. BY SIGNING IT YOU WILL BE WAIVING YOUR KNOWN AND UNKNOWN CLAIMS.
YOU MUST SIGN THIS AGREEMENT A SECOND TIME ON THE TERMINATION DATE (MARCH 31, 2017) AND DELIVER A SIGNED COPY OF THIS AGREEMENT TO EDWARD RUSSELL, HUMAN RESOURCES. IF YOU FAIL TO DO SO, YOU WILL NOT RECEIVE THE SEVERANCE PAYMENT DESCRIBED IN IT.
YOU MAY REVOKE THIS AGREEMENT IF YOU REGRET HAVING SIGNED IT ON A PARTICULAR OCCASION. TO DO SO, YOU MUST DELIVER A WRITTEN NOTICE OF REVOCATION TO EDWARD RUSSELL, HUMAN RESOURCES, BEFORE SEVEN 24-HOUR PERIODS EXPIRE FROM THE APPLICABLE TIME YOU SIGNED IT (“REVOCATION PERIOD”). IF YOU REVOKE THIS AGREEMENT, IT WILL NOT GO INTO EFFECT AND YOU WILL NOT RECEIVE THE BENEFITS, INCLUDING THE SEVERANCE PAYMENT, DESCRIBED IN IT. EACH EFFECTIVE DATE OF THIS AGREEMENT IS THE EIGHTH DAY AFTER YOU SIGN WITHOUT REVOCATION.

[SIGNATURE PAGE TO FOLLOW]

6


Exhibit 10.1

PLEASE READ CAREFULLY. THIS AGREEMENT INCLUDES A RELEASE OF ALL KNOWN AND UNKNOWN CLAIMS. To signify their agreement to the terms of this Agreement, the parties have executed this Agreement on the dates set forth under their signatures which appear below.

EXECUTE NO LATER THAN 21 DAYS AFTER RECEIPT OF AGREEMENT
PURSUANT TO SECTION 2 OF AGREEMENT


KIMBERLY M. SMITH
 
FIBROCELL SCIENCE, INC.
 
 
 
 
 
/s/ Kimberly M. Smith
 
By:
John M. Maslowski
 
 
 
 
 
Print Name:
Kimberly M. Smith
 
Title:
Chief Executive Officer
 
 
 
 
 
Date:
March 3, 2017
 
Date:
March 3, 2017



PLEASE READ CAREFULLY. THIS AGREEMENT INCLUDES A RELEASE OF ALL KNOWN AND UNKNOWN CLAIMS. To signify their agreement to the terms of this Agreement, the parties have executed this Agreement on the dates set forth under their signatures which appear below.

EXECUTE ON TERMINATION DATE
PURSUANT TO SECTION 3 OF AGREEMENT


KIMBERLY M. SMITH
 
FIBROCELL SCIENCE, INC.
 
 
 
 
 
/s/ Kimberly M. Smith
 
By:
 
 
 
 
 
 
Print Name:
 
 
Title:
 
 
 
 
 
 
Date:
 
 
Date:
 



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