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Published by dchevy03, 2017-05-09 12:25:50

ABP sorted

ABP sorted

DESIGNED
AND MADE
WITH
INTEGRITY

Our products, our commitments, our conduct

The Chart Code of
Ethical Business Conduct

The Chart Code of Ethical Business Conduct

To all Chart employees,

Our business is about design and construction – envisioning and
manufacturing products that perform outstandingly and that stand
the test of time. We are also in the continuing business of building
such a company – a company with staying power to serve our
customers, shareholders, employees and other stakeholders very
well for years to come. The Chart values are essential building
blocks for such a company. Living these values helps us to build a
reputation as a company that others want to do business with and
that is a great place to work.

This Code of Ethical Business Conduct supports Chart’s values –
especially our value of integrity. This Code is not intended to make
you ethical – we already ensured that when the company hired you.
It is meant to assist you with challenging issues that arise for all
of us in daily work. The Code is, in essence, another tool to use in
helping us to build the kind of company we want.

The Code’s standards apply to most situations you will encounter.
Where the Code does not apply directly, we count on you to make
ethical decisions. Whenever you are uncertain about how to apply
this Code’s standards, we ask that you contact your supervisor or
another manager for guidance.

It is your duty to understand these standards. It is also your
responsibility to report any situation where another employee has
not followed the standards.

I expect all employees to put into practice the Code’s standards. I
can assure you that senior management and I will do the same.

Samuel F. Thomas
Chairman, CEO & President

1

Designed and Made with Integrity

Chart Mission

To be a leader in high growth global
niches for engineered equipment,
systems and aftermarket to the energy,
industrial gas and biomedical markets,
and the:

Supplier of choice due to our
product and service value to
customers, and

Employer of choice because we
are a safe, ethical, challenging
and rewarding place to work
with high opportunity for
individual growth.

2

The Chart Code of Ethical Business Conduct

Chart Values

Safety

If it can’t be done safely, don’t do it.

A job is well done only if it is done safely. Most accidents and injuries are
preventable – no business objective is so important that it will be pursued at
the sacrifice of safety.

Integrity

Do what you say and do it responsibly.

How do you demonstrate integrity? Honesty, trust, respect, fairness,
responsibility and the free exchange of ideas form the foundation of integrity.

Customer driven

They are why we’re here – we are dedicated to meeting the
expectations and requirements of our customers.

We support our customers best when we understand their needs and drive
innovation in every aspect of our business.

Employer of choice

Challenging, rewarding, individual growth opportunities.

Our employees are our most valuable resource – our success depends on you.
It is Chart’s goal to provide each employee with a challenging and rewarding
experience that allows personal and professional growth.

Actively seek profitable growth

Pursue all appropriate value increase strategies; don’t
apologize for value prices.

We design and deliver quality products at a value that is often immeasurable,
but highly significant to our customers’ business.

3

Designed and Made with Integrity

Contents

Page

CEO Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chart Mission and Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Demonstrating Integrity with Our Co-Workers . . . . . . . . . . . . . . . . . . .8

Workplace Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Respect and FairTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Employee Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Demonstrating Integrity with Our Business Partners . . . . . . . . . . . . . 10
Gifts and Entertainment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Fair Competition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Anti-Corruption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Protecting Others’ Business Information . . . . . . . . . . . . . . . . . . . . .12
Working with Governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Business Across Borders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Import Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Export Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Money Laundering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Embargoes & Boycotts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Environmental Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Demonstrating Integrity with Our Investors. . . . . . . . . . . . . . . . . . . . . 14
Integrity of Financial Systems and Filings . . . . . . . . . . . . . . . . . . . . 14
Accurate Books and Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Filings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Financial Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Communications with Outside Parties . . . . . . . . . . . . . . . . . . . . . . .15
InsiderTrading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Conflicts of Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Outside Activities and Financial Interests. . . . . . . . . . . . . . . . . .16

4

The Chart Code of Ethical Business Conduct

Responsible Use of Company Assets . . . . . . . . . . . . . . . . . . . . . . . .16
Physical Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Computer and Electronic Resources . . . . . . . . . . . . . . . . . . . . . .16
Company Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Community and Political Involvement . . . . . . . . . . . . . . . . . . . . . . .17
Resources to Get Advice and Report Misconduct . . . . . . . . . . . . . . . .18

Confidential Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Anonymous Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Non-retaliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Decision Making Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

5

Designed and Made with Integrity

Getting Started

Our Values and the Code

Designed and Made with Integrity, the Chart Code
of Ethical Business Conduct (the “Code”), is about
inspiration and expectations. It is about being so inspired
in what we do that we convey this enthusiasm to our
customers and all the people we deal with, who see the
tremendous value in being aligned with us. The Code also
reflects the expectations we have for one another to act with
integrity throughout our workday, on behalf of our co-
workers, our business partners and our investors.

Integrity is our foundation and should guide every action
and decision we make.

Characteristics of Integrity

Honesty Fairness

Trust Responsibility

Respect Free Exchange of Ideas

Understanding Our Responsibilities to Act with
Integrity

Each of us should read and understand the Code and follow the Code’s standards
in our daily work. However, we should each view the Code as the minimum
standard of conduct since we also are expected to follow all laws, rules, regulatory
orders and regulations of the United States, because this is the location of Chart’s
headquarters, as well as those of the countries where we work. If compliance with

6

The Chart Code of Ethical Business Conduct

the Code ever conflicts with the law, you must comply with the law. The Code is
also meant to supplement, and not meant to replace, Chart’s Corporate Policies
(see “Resources to Get Advice and Report Misconduct” on page 18) and other
applicable Chart polices, some of which are referenced throughout this Code.
If we observe or even hear about potential misconduct, we should contact our
supervisor or other resource. In addition, we should always seek help whenever
we are not sure about what decision best meets the Code’s standards.

Supervisors and managers should have detailed knowledge of the Code and
relevant laws and regulations. This knowledge helps supervisors and managers to
be useful sources of guidance for employees who report to them. Most important,
supervisors and managers set the example of responsible actions by demonstrating
the Code’s principles every day.

The Code applies to all directors, officers and employees
(collectively referred to throughout this Code as
“employees”) who work for Chart Industries, Inc. and
all majority-owned subsidiaries worldwide (collectively
referred to throughout this Code as “Chart” and
the“company” interchangeably). In addition to this Code,
the Chart Officer Code of Ethics also applies to Chart
executive officers. Only the Board of Directors has the
authority to approve a waiver of any provision of the Code
for a member of the Board of Directors or an executive
officer, which shall be disclosed in accordance with the
Sarbanes-Oxley Act of 2002. Only the Chart General
Counsel has the authority to approve a waiver of any
provision of the Code for any other employee. The company
will also disclose promptly any changes to this Code.

7

Designed and Made with Integrity

Demonstrating
Integrity with Our
Co-Workers

Guidance: With a core value of being the employer of choice in
our communities, Chart is committed to providing
Laws, regulations and a productive and safe work environment. This
local customs related to the environment will reward us by encouraging and
operation of a business vary supporting our personal and professional growth.
among countries. This is
especially true for employee We demonstrate integrity with each other as we share
relations. It is important a sense of responsibility, honesty, trust, respect, and
that we understand how the fairness.
company’s standards apply
to local employment matters Workplace Safety
and, if unsure, that we seek
advice. At Chart, we never sacrifice safety for any reason; as our value states: “If
you can’t do it safely, don’t do it”. Each of us has a responsibility to our
customers, co-workers and ourselves to be safe in everything we do. We
rely on each other to maintain a safe environment. Chart prohibits violent
behavior of any kind. Also, the company will not tolerate anyone on
workplace premises in an impaired condition due to the use of alcohol or
drugs.

Respect and Fair Treatment

Chart relies on us to always treat our co-workers with respect. Consistent
with the principles of respect and fairness, Chart is committed to recruiting,
hiring, training and promoting based on an individual’s qualifications
and company needs. No employment decision should be based on a
person’s characteristics that are improper or illegal to consider. Certain
countries where we work prohibit employment discrimination based on an
individual’s personal characteristics, such as race, age or gender.

8

The Chart Code of Ethical Business Conduct

The company will not tolerate any form of disrespectful conduct, including Guidance:
harassment of co-workers. Such behavior can include derogatory comments,
unwanted sexual advances, creation of a hostile work environment or offers The European Union and its
of job advantages in exchange for sexual favors. member countries have espe-
cially strict legislation and
Employee Information procedures in this area. Con-
tact your Ethics Representa-
The company respects our privacy and works hard to ensure privacy of our tive if you have any responsi-
personal data, such as salary or health information. Personally identifiable bility for handling personally
information is handled in a safe and secure manner. Chart follows detailed identifiable information.
procedures that specify how the company can share certain information or
even transfer the information from one country to another. For questions,
consult an Ethics Representative.

9

Designed and Made with Integrity

Demonstrating
Integrity with Our
Business Partners

Example: Chart enjoys the trust of its customers, suppliers and
agents because we act with integrity. Our reputation for
In parts of Asia, it is the design and manufacture of high quality products and
traditional to regularly systems, driven by customer needs, is supported through
exchange gifts in business honest behavior guided by the Code.
relationships. We should
respect local customs while We constantly strive to do business fairly and ethically.
complying with company And we seek business partners to share our commitments
policies. to open and trusting relationships.

Gifts and Entertainment

Chart buys and sells on the basis of such factors as quality, reliability and price.
We act with integrity and transparency in our business transactions. All gifts
and entertainment, whether we give or receive them, should be modest and of
reasonable value and not be intended to influence either a sale or purchase. An
Ethics Representative is responsible for pre-approving gifts that exceed $250,
except for reasonable and customary business entertainment or business meals.
If we receive gifts that exceed $250 that we cannot politely decline or return,
we should contact an Ethics Representative for guidance.

Each country where Chart operates has local customs related to the exchange
of gifts and entertainment. Business unit or country managers with questions
about the appropriateness of these local customs should contact an Ethics
Representative for guidance.

10

The Chart Code of Ethical Business Conduct

Fair Competition Examples:

We are dedicated to vigorous, fair competition. We also are committed Potentially unfair competition
to our value of meeting customer expectations and requirements – and practices include:
always fairly. Certain types of interactions between the company and • Collaboration among
our suppliers, customers and competitors are not allowed. For instance,
laws and company policy prohibit: competitors as to price or
market terms
• Specified types of collaboration among competitors, such as
sharing price or strategic information or agreeing to divide up • Unfair use of market position
groups of customers, markets or territories
• Working with customers to
• Agreements with customers or suppliers that unfairly restrict set resale prices
competition, such as inappropriately requiring customers to
purchase one product in order to purchase an unrelated product • Predatory pricing in certain
or service situations

In the countries where we do business, the fair competition laws
can be very complicated. We should seek guidance from a company
attorney or an Ethics Representative if we have questions about specific
competition issues.

We will use only ethical and legal means to gather marketing and
business information related to our competitors. The most appropriate
sources of this information include public information.

Example:

We should avoid interactions
with competitors that could
be interpreted as collusion or
manipulation of prices. We
should be especially sensitive
to appearances of improper
collaboration when we attend
industry conferences, industry
association meetings and trade
shows or in any communica-
tions with competitors.

11

Designed and Made with Integrity

Guidance: Anti-Corruption

U.S. controls restrict ex- Bribery violates Chart’s commitment to fair dealing, and we reject
porting certain products, participation in all such acts of corruption. Corruption generally is prohibited
services, technical data and throughout the world. We face heavy penalties as individuals and as a
software to other countries, company for violations, which can include both civil and criminal penalties.
and re-exporting those items Bribes can come in the form of money, services or lavish gifts. Requests
from one non-U.S. destina- for bribes may be explicit or disguised and can involve distributors or other
tion to another. U.S. export agents. We must be vigilant for any arrangements that could lead to bribery,
laws also prohibit export especially in countries with a cultural acceptance of corruption. It is especially
or re-export of products to important that we exercise due diligence in the selection and monitoring of
a prohibited country, to a our agents and distributors. It is the responsibility of all employees of Chart to
prohibited person, or for be familiar with and comply with Chart’s Corporate Anti-Bribery Policy.
a use prohibited by export
laws. All employees are Protecting Others’ Business Information
expected to comply with any
Chart-issued export compli- Occasionally, suppliers and customers will provide their proprietary
ance policies, manuals and information to us as part of a joint project. For example, we may help develop
directives. new uses for a supplier’s raw material or we may create a proprietary design
for a customer. Consistent with our commitment of respect and privacy, we
must treat this information confidentially, protect it from improper disclosure,
and only disclose it to others if authorized.

Working with Governments

We wish to have the same reputation of integrity with governments as we
do with private sector customers. When we do business with governments
and government agencies, it is essential that we follow the specific rules and
regulations that typically control government procurement. Also, we are
respectful of and will cooperate fully with officials who regulate our business.

Business Across Borders

Import Controls

We rely on accurate import records. Specifically, these records should show
the correct classification and valuation of imported items. All additional
import documentation should be accurate and comply with applicable
regulations.

12

The Chart Code of Ethical Business Conduct

Export Controls Example:

Many countries have laws that restrict exporting products and technology, Due to the Arab League’s
especially any items used for direct military purposes. The definition boycott of Israel, letters of
of export can be broad and complicated. For example, an export can credit from banks located in
include electronic transmission of intellectual property, like drawings and the Middle East may require
knowledge, even between Chart employees located in different countries. that no part of the items
We are responsible for complying with Chart’s Trade Law Policy, which is purchased be manufactured
designed to ensure compliance with export and other trade laws. We should in Israel or be transported
contact an Ethics Representative for questions on specific transactions. on an Israeli vessel. U.S.
law prohibits complying
Money Laundering with these requirements.

Individuals involved in narcotics trafficking, terrorism-related or other
illicit activities may attempt to use a legitimate business to process
illegally obtained funds, a practice called “money laundering”. Most
countries forbid money laundering. To protect Chart’s interests, we should
always conduct business only with reputable suppliers and customers and
be reasonably aware of the underlying basis of any business transactions.

Embargoes & Boycotts

Many countries forbid the restriction of business with certain countries,
their companies and citizens. As a U.S.-based company, we are obligated
to comply with U.S. guidelines, which may prohibit U.S. companies from
cooperating with restrictive trade practices or economic embargoes that
other nations impose. We should refer any embargo-related requests to an
Ethics Representative.

Environmental Protection

Chart appreciates the opportunity to be a part of a local community, and
we care about our impact on these communities. Chart follows the spirit
as well as the stated requirements of environmental laws and regulations.
We are committed to reducing our environmental impact wherever
economically feasible.

13

Designed and Made with Integrity

Demonstrating
Integrity with Our
Investors

Examples: Chart investors count on us to achieve growth in company
sales and profit, which supports the company value of
Three specific requirements actively seeking profitable growth. To meet investors’
are particularly important in expectations, we ensure honesty and accuracy in our
the area of financial reports: financial systems, make wise use of company resources
• We must not intentionally and demonstrate our unwavering commitment to act for
the company with integrity.
misrepresent Chart’s
financial performance or Each of us is expected to act with integrity as we meet the
otherwise intentionally requirements for maintaining investor confidence in Chart.
compromise the integrity
of the company’s reports, Integrity of Financial Systems and Filings
records, policies or
procedures. Chart depends on accurate reports, such as production and sales records, to help
run the business. As a publicly listed company, Chart also meets its obligations
• We are expected to to submit accurate and honest reports to comply with securities regulations.
cooperate with both We all have an important role in providing information for, preparing and filing
internal auditors and these reports.
our independent auditors
in their reviews of our Accurate Books and Records
financial systems and
records. Each of us is responsible for ensuring that all recordkeeping is accurate and
timely. Time cards, inventory counts, expense reports and the financial books of
• The Audit Committee of the account are all examples of these records.
Board of Directors plays an
important role in ensuring Filings
the integrity and accuracy
of Chart’s financial systems We use these detailed records to prepare financial reports and other documents,
and reports. The CEO and which we then submit to regulatory authorities, including the U.S. Securities and
senior financial officers are Exchange Commission and the NASDAQ Stock Market, the exchange where
expected to promptly bring our stock is listed. We should take extra care to make sure that these filings are
evidence of inaccurate full, fair, accurate, timely and understandable.
disclosures, deficiencies
in internal controls or
fraud to the attention of
the Audit Committee of
the Board of Directors. If
any of us become aware of
such problems, we can use
the Ethics Hotline to bring
such matters to the Audit
Committee’s attention.

14

The Chart Code of Ethical Business Conduct

Financial Systems

Chart follows strict accounting principles, standards and procedures as called for
in legislation and principles such as the U.S. Sarbanes-Oxley Act and generally
accepted accounting principles. As a result, the company strives to prepare its
financial statements with accuracy and integrity. In all countries where Chart
operates, we should follow the same strict principles, standards and procedures since
results from these countries are an integral part of the overall Chart reporting system.

Employees who work in finance and accounting ensure that co-workers follow
all controls and procedures. If we observe or suspect dishonesty or abuse of the
procedures, we are expected to report the situation immediately through the
reporting mechanism or the Chart Ethics Hotline. The separate Chart Officer Code
of Ethics provides additional information related to financial systems and reporting.

Communications with Outside Parties

As a publicly traded company, Chart is obligated to provide disclosure of Examples:
significant information to the public. Chart has designated specific individuals
to serve as official spokespersons for the company. These spokespersons use all
reasonable efforts to provide complete, accurate, objective, relevant, timely and
understandable answers to all inquiries. Other employees should not respond to
any requests for company information from investors, reporters, financial analysts,
friends or others but refer these requests to the designated spokespersons. All
communications made to public audiences on behalf of Chart, including formal
communications and presentations made to investors, financial analysts, industry
groups or the press, require prior approval of the Chief Financial Officer or his
designee. However, if you believe that any disclosure is materially misleading,
or if you become aware of any material information that you believe should be
disclosed to the public, it is your responsibility to bring this information to the
attention of the Chief Financial Officer or General Counsel.

Insider Trading Potential insider information
can include:
At Chart we understand the importance of acting with honesty and respect for the • The unexpected signing
company. One implication of this commitment is that we cannot purchase or sell
securities of Chart or a business partner if we know important information about that of a multi-million dollar
company that has not been made public. Such a purchase or sale is called “insider contract with a new
trading”, which is illegal in most countries. In addition, we cannot provide this customer
information to another individual who is likely to trade the company’s securities
based on this information, a practice called “tipping”. This type of conduct violates • A major acquisition
Chart’s Insider Trading Policy. All employees of Chart have the responsibility to be
familiar with and comply with Chart’s Insider Trading Policy. Be aware of whether • A significant new product
you know important, non-public information about either Chart or a business partner line that has not been
and so are restricted from trading that company’s securities. publicly announced

.

15

Designed and Made with Integrity

Examples: Conflicts of Interest

• We are not allowed to use We demonstrate integrity with each other and with Chart when we share a
ideas or opportunities sense of responsibility, honesty, trust, respect and fairness. This personal
we discover on the job commitment to integrity is jeopardized when our personal activities
for personal gain. Also, conflict, or even appear to conflict, with the company’s interests. The
we should never compete company will investigate all potential and actual conflicts of interest.
with the company.
Outside Activities and Financial Interests
• We should not conduct
company business with Our loyalty to Chart is important since the company is our principal source
family members or close of employment. We should avoid additional work, either paid or unpaid,
friends without specific that diverts our commitment to Chart or impairs our ability to be objective
authorization. in performing our work. If a potential conflict arises, we should discuss the
matter with our manager.
• The company may hire
more than one member We should also avoid financial interests in suppliers, customers and
of a family if each competitors unless these are securities of a publicly traded company or held
person is well qualified through an investment where we do not control the trading of individual
to meet a specific hiring securities, such as a mutual fund.
requirement. However,
we should not directly Responsible Use of Company Assets
or indirectly supervise
the job performance of a To meet our commitments to investors and Chart, we should make
relative. responsible use of all company assets. These assets include physical assets,
computers and other electronic systems and intangible assets, like business
information.

Physical Assets

We should carefully and safely use tools, equipment, supplies and
inventories. We should never damage equipment or use manufacturing
supplies for personal use such as a home improvement project.

Computer and Electronic Resources

Chart’s computers and communication equipment, including phones
and information systems, email and Internet connections, are meant
for business purposes. When we communicate using these systems,
we should do so professionally. With our manager’s approval, we may
make very limited personal use of equipment such as the phone, email or
photocopier. Where allowed, Chart may monitor our activity to ensure
employees are not misusing these resources. All employees of Chart have
the responsibility to be familiar with Chart’s Electronic Communications
Policy that is applicable to them.

16

The Chart Code of Ethical Business Conduct

Company Information Guidance:

Chart’s non-public information is a valuable company asset. Certain In some countries, the local
information is especially critical, and we should treat it as confidential. culture views hiring and super-
Examples may include financial information, corporate developments and vising family members differ-
plans, marketing strategies, customer and supplier lists, new product plans ently than in the U.S. Country
and product or process designs. We should discuss confidential information managers should contact an
with our co-workers only on a “need-to-know” basis. We must safeguard Ethics Representative with
confidential information during and after our employment with Chart from questions about the Chart stan-
disclosure outside Chart, except when required by law or for Chart’s business dard on hiring family members
purposes and appropriate steps have been taken to prevent misuse of the of current employees.
information.

“Intellectual property” is information or knowledge created for Chart and
which the company owns and protects through patents, copyrights, trade
marks or service marks. Certain intellectual property, called “trade secrets”,
is critical to the company’s operations and success. We are expected to be
vigilant during and after our employment with Chart in maintaining the
confidentiality of these trade secrets to properly safeguard their value to
Chart. Our individual work product, such as an improved manufacturing
process or a patentable invention, belongs to Chart.

Community and Political Involvement

Chart encourages us to become involved in the local community. In doing
so, and reflecting our responsibility to the company, we should not associate
Chart with any particular cause, candidate, political party or issue. In addition,
we should respect company assets and not use any company resources such as
computers or photocopiers to support these activities.

Chart must comply with all laws relating to political contributions and
lobbying expenditures. Any direct or indirect contributions to, or expenditures
incurred on behalf of, any political party or candidate for political office in
any country by the company (or by any employee on behalf of the company)
are prohibited unless approved in advance by the General Counsel.

17

Designed and Made with Integrity

Resources to Get
Advice and Report
Misconduct

Examples: We should seek answers for ethics and compliance-
related questions. We must also report incidents of
In our day-to-day work, possible misconduct.
we may encounter various
ethical issues. For instance: If your concerns relate to accounting, internal controls or
• We may need advice to auditing matters, you may contact the Audit Committee
through the Ethics Representatives or the Chart Ethics
decide if an action is legal Hotline.
or ethical
• We may observe Resources
misconduct
• We may observe activities Chart has several resources to address ethics and compliance issues.
that could damage the
company’s reputation 1. Read the Chart policies that relate to important topics. Policies provide
additional details and are accessible on SharePoint in the Corporate
Governance section.

2. Speak to your supervisor or other manager within your organization.

3. Email the Chart Ethics Representatives:
[email protected].

4. Contact the Chart Ethics Hotline:
• Voicemail: 1-800-868-8541 in the US. Go to www.ethicspoint.com
for toll-free numbers outside the US.
• Web Interface: www.ethicspoint.com

18

The Chart Code of Ethical Business Conduct

Confidential Reporting Guidance:

The company treats all reports of ethics or compliance concerns, including Employees are required to
contacts to the Ethics Hotline, as confidential. Management shares information promptly report violations
only with those involved in the investigation of any alleged misconduct. In or suspected violations of
rare cases, the company may need to provide information regarding a report of the Code using the resources
suspected misconduct as part of a legal investigation or for business purposes. listed on the preceding page.

Anonymous Reporting

The Ethics Hotline allows us to report a concern anonymously, if we prefer. Be
advised that some concerns cannot be fully investigated without the identity of
the person reporting the concern.

Outcomes

Chart has a process for conducting investigations of alleged incidents of
misconduct. Information related to an investigation is shared only with
individuals involved in the investigation. The purpose is to determine the
accuracy, severity, frequency and intent of the misconduct. Based on the
investigation’s findings, the Chief Compliance Officer and the General Counsel
will decide whether misconduct occurred and the appropriate disciplinary
action, including termination of employment if appropriate. Adherence to
the principles of the Code is a condition of continued employment with the
company. Where laws have been violated, the company may report violators
to the appropriate authorities. In some situations, the responsible individual
also may be subject to civil or criminal prosecution. If Board members or
company officers are involved in allegations of misconduct, the Board will
follow established procedures for conducting the investigation and determining
disciplinary measures.

Non-retaliation

The company prohibits retaliation or threats of retaliation against any of us
who, in good faith, reports a possible incident of misconduct. The company
will investigate reports of suspected retaliation and discipline responsible
individuals. Every employee also is protected by Chart’s Whistleblower Policy.

19

Designed and Made with Integrity

Decision Making
Guidelines

The Code cannot discuss all possible ethics issues. In some
situations, standards may seemingly conflict. At other times
an employee may find that the situation is unclear. In these
situations, we can gain help in making the right decision by
asking ourselves these questions:

• Do I have all the facts related to the decision?
• Would the decision that I am considering meet all applicable

laws and regulations?
• Would the decision meet the requirements of company policies?
• Would the decision be consistent with Chart’s commitment to

integrity and our other values?
• Would the decision be consistent with this Code?
• How would the decision be perceived by the media, our investors

and regulators who oversee our business operations?
• Would the decision be the right thing to do when compared to

broadly accepted values?

If the right decision is still not clear, we should seek guidance
from one of the resources listed on page 18. You do not have to
make this decision alone.

20

The Chart Code of Ethical Business Conduct

Certification

I acknowledge that I have received the Chart Code of Ethical Business
Conduct (the “Code”) and am responsible for familiarizing myself with the
standards it establishes.
I understand the company’s expectations that I act with integrity when
conducting company business.
I agree and understand that it is my obligation to follow fully and abide by
the standards in the Code.
I understand that, if I violate the standards in the Code, I can be subject to
disciplinary action, including termination of employment. In addition, I
understand that some violations may result in civil or criminal prosecution.
I acknowledge that I am not aware of any violations of the Code
(if yes, please describe violation(s)).

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
I understand that I have an on-going obligation to notify the company if I
become aware of any violations of this Code at any time in the future.

Signature _______________________________ Date_______________

Print Name _________________________________________________

21



INTELLECTUAL PROPERTY FORMS
FOR

HUMAN RESOURCES

Chart Industries, Inc.

June 20, 2001

File: Intellectual Property Program/DJG/6-20-01/Human Resources/c

EMPLOYEE CONFIDENTIALITY AND NONCOMPETE AGREEMENT

Employee's Name: ___________________________________________

Chart Business Address: __1300 Airport Drive, Ball Ground, GA 30107

Date: _____________________

1. As a condition of being offered employment with Chart Inc. and/or any of its affiliated companies
(collectively "Chart") and as consideration in part for the salary or wages paid for my services during my
employment:

(a) I agree to promptly inform Chart of the full details of all my inventions, discoveries,
concepts, and ideas (collectively called "Developments"), whether patentable or not including, but not limited
to hardware and apparatus, processes and methods, formulae, computer programs and techniques, as well as
any improvements and related knowledge, which I conceive, complete, or reduce to practice (whether alone
or jointly with others) while I am employed by Chart and (1) which relate to the present or prospective
business, work or investigations of Chart, or (2) which result from any work I do using any equipment,
facilities, materials or personnel of Chart, or (3) which result from or are suggested by any work which I
may do for Chart.

(b) I agree to assign, and I do assign, to Chart or to Chart's designee, my entire right, title and
interest in (1) all Developments, (2) all trademarks, copyrights and any other rights that I may have to said
Developments, and (3) all patent applications filed and patents granted on any Developments, including
those in foreign countries which I conceive or make (whether alone or with others) while employed by Chart
or within one year of the end of my employment (if conceived as a result of my employment).

(c) Both while employed by Chart and afterwards, I agree to execute any papers that Chart may
consider necessary or helpful to obtain or maintain patents, whether during the prosecution of patent
applications or during the conduct of an interference, litigation, or other matter (all related expenses to be
borne by Chart).

(d) I agree not to use or disclose (except as my Chart duties may require) any of Chart's
Confidential Information (whether or not conceived, originated, discovered, or developed by me) unless
Chart first consents in writing. I understand that this obligation remains with me even after my employment
with Chart ends. I understand that "Confidential Information" means information or material: (1) which is
not generally available to or used by others, or (2) the utility or value of which is not generally known or
recognized as standard practice, whether or not the underlying details are in the public domain. I understand
that Confidential Information includes but is not limited to: (1) blueprints, designs, manufacturing detail
drawings, customer names lists, customer files, pricing information, quotations and other information or
materials which relate to Chart's inventions, technological developments, know-how, purchasing, accounting,
merchandising, or licensing; (2) trade secrets as defined in the Restatement of Torts which I accept as an
appropriate statement of law; (3) software in various stages of development (source code, object code,
documentation, diagrams, flow charts), designs, drawings, specifications, models, data, and customer
information; and (4) any information of the type described above which Chart obtained from another party
and which Chart treats as proprietary or designates as confidential, whether or not owned or developed by
Chart.

1

File: Intellectual Property Program/DJG/6-20-01/Human Resources/c

(e) I agree to deliver to Chart, on the date that my employment ends (or promptly upon request), all
documents and things in my possession pertaining to the business of Chart, including, but not limited to,
Confidential Information. If documents and things pertaining to the business of Chart or originating
with Chart come into my possession after my employment ends, I will promptly deliver them to
Chart.

(f) I agree, for two (2) years following the end of my employment with Chart and within the global
geographical area including the United States, not to engage in or contribute my knowledge to any work
which is competitive with or similar to a product, process, apparatus or service on which I worked while at
Chart at any time during the period of two (2) years immediately before my employment ended. I agree that
the geographic area set forth in this clause is divisible so that if this clause is invalid or unenforceable in an
included geographic area, that portion of the geographic area is severable and this clause remains in effect for
the remaining included geographic areas in which the clause is valid. I understand that I will be permitted to
engage in the work or activity described in this subparagraph if I provide Chart with clear and convincing
written proof (including assurances from my new employer and me) that the contribution of my knowledge to
that work or activity will not cause me to disclose, base judgment upon, or use any Confidential Information.
Chart will furnish me a written consent to that effect if I provide the foregoing required written proof and
assurances. As such, I agree not to engage in such work or activity until I receive the written consent from
Chart.

2. I represent that, except as I have written below, I have no agreements with or obligations to others
concerning any Developments or Confidential Information. Nor do I have any agreements or obligations that
might conflict with this Agreement.

3. I understand that this Agreement constitutes the complete understanding between Chart and me on
the subject matter of this Agreement and that this Agreement supersedes all prior representations and
understandings, whether oral or written.

4. I agree that my obligations under this Agreement are binding upon my heirs, executors,
administrators, or other legal representatives or assigns, and that this Agreement inures to the benefit of
Chart, its successors, and assigns.

5. I understand that Chart's rights and obligations under this Agreement may not be changed, modified,
released, discharged, abandoned or otherwise terminated, in whole or in part, except in writing, signed by an
authorized officer of Chart.

6. When my employment with Chart ends, I will, if requested by Chart, reaffirm my obligations
described in paragraph 1 of this Agreement, including my understanding of the importance of keeping
confidential Chart's Confidential Information.

Accepted and Agreed to as the date first written above:

WITNESS EMPLOYEE

______________________________ _____________________________
Chart Designated Representative (Sign Name in Full)

_______________________________ ______________________________

(Print full name) (Print full name)

2

File: Intellectual Property Program/DJG/6-20-01/Human Resources/c



Chart Industries, Inc.
Social Media Policy

1. Purpose and Scope

As used herein, the "Policy" means this Chart Industries, Inc. Social Media Policy, and "Chart" or the "Company" means Chart
Industries, Inc. and its subsidiaries. This Policy applies to you if you are a Chart employee or contractor who creates or contributes to
blogs or microblogs (e.g., Company or personal blogs, Twitter, Tumblr), wikis (e.g., Wikipedia), social networks (e.g., Facebook,
LinkedIn, Google+), virtual worlds, or any other kind of social media (e.g., YouTube, Flickr, Pinterest, Instagram), regardle ss of
whether your activity is professional or personal, and whether or not it takes place on or off of Chart's internal network. Both inside
and outside the Company, when you are engaging in social media, Chart has specific expectations of your conduct and of the
information you share online.

The information in this Policy is subject to the applicable country, state, and/or local laws in each Chart location, which will take
precedence in the case of any conflict with this Policy. Employees must comply with their local legal social media requirements. As
necessary, Chart may choose to adopt regional or country-specific social media policies.

2. Expectations of Use

The Company's existing core policies provide the foundation for our Social Media Policy. Company employees are subject to Chart's
Code of Ethical Business Conduct in every public setting. As the Code of Ethical Business Conduct makes clear, one of our guiding
values is integrity. Integrity should guide our conduct and relationships with co-workers, business partners, customers and suppliers,
as well as our conduct on social media platforms. In addition to the Code of Ethical Business Conduct and this Policy, employees'
conduct online is also subject to Chart's Insider Trading Policy and Chart's Electronic Communications Policy.

Ultimately, if it is outside the scope of your Company responsibilities, you are solely responsible for what you post online. Before
creating online content, consider some of the risks and rewards involved. Unless the Company has specifically authorized your online
activity, if your conduct online adversely affects your job performance, the performance of your colleagues, or if it injures our
customers, suppliers, the people who work on Chart's behalf or Chart's legitimate business interests, it may result in disciplinary action
against you, up to and including termination.

A. Appropriate Conduct and Personal Information

Respect the privacy and feelings of others. Without their prior consent, or unless explicitly authorized by the Company, do not identify
other Chart employees on social media sites (including by name or variation of name). Do not make inappropriate comments about
employees, customers, suppliers or business partners, or use personal blogs or web sites in a way that could be viewed as attacking,
abusive or bullying. Conduct that could subject you to disciplinary action, up to and including termination, includes posts that are
aimed at harming someone's reputation, or posts that could contribute to a hostile work environment on the basis of race, sex,
disability, religion, or any other protected status.

False or defamatory statements or the publication of an individual's private details could result in legal liability for Chart and you.

B. Proprietary and Confidential Information

You must maintain the confidentiality of Chart trade secrets and confidential information on social media platforms. Trade secrets
could include information regarding the development of systems, processes, products, know-how and technology. Confidential
information, not previously made public by a Chart-authorized source, should never appear in your social media posts. This means
you should not post information related to any as-yet unpublicized Company products, strategies, financial information, staffing
changes of key executives, or any financial or commercial data related to the Company, our employees, customers or partners. You
must not discuss the Company’stechnological developments before they are made public. Disclosures of such developments before
relevant patent applications have been led can limit the Company’s ability to obtain patent protection, in some cases coemtelpyl.
Discussing pending patent applications before they are published can also harm the competitive interests of the Company.













Voluntary Self-Identification of Disability Form CC-305
Why are you being asked to complete this form? OMB Control Number 1250-0005

Expires 1/31/2017

Page 1 of 2

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to
qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if
you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will
choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used
against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may
become disabled at any time, we are required to ask all of our employees to update their information every
five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment
because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition
that substantially limits a major life activity, or if you have a history or record of such an impairment or
medical condition.

Disabilities include, but are not limited to:

• Blindness • Autism • Bipolar disorder • Post-traumatic stress disorder (PTSD)
• Deafness • Cerebral palsy • Major depression • Obsessive compulsive disorder
• Cancer • HIV/AIDS • Multiple sclerosis (MS) • Impairments requiring the use of a wheel chair
• Diabetes • Schizophrenia • Missing limbs or • Intellectual disability (previously called m ental

• Epilepsy • Muscular partially missing limbs retardation)
dystrophy

Please check one of the boxes below:
YES, I HAVE A DISABILITY (or previously had a disability)
NO, I DON’T HAVE A DISABILITY
I DON’T WISH TO ANSWER

Your Name Today’s Date

Voluntary Self-Identification of Disability Form CC-305
Reasonable Accommodation Notice OMB Control Number 1250-0005

Expires 1/31/2017

Page 2 of 2

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of
reasonable accommodation include making a change to the application process or work procedures, providing
documents in an alternate format, using a sign language interpreter, or using specialized equipment.

i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal
employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal
Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond
to a collection of information unless such collection displays a valid OMB control number. This survey should take about
5 minutes to complete.



Form W-4 (2017) The exceptions don’t apply to supplemental wages Nonwage income. If you have a large amount of
greater than $1,000,000. nonwage income, such as interest or dividends,
consider making estimated tax payments using Form
Purpose. Complete Form W-4 so that your Basic instructions. If you aren’t exempt, complete 1040-ES, Estimated Tax for Individuals. Otherwise,
employer can withhold the correct federal income the Personal Allowances Worksheet below. The you may owe additional tax. If you have pension or
tax from your pay. Consider completing a new Form worksheets on page 2 further adjust your annuity income, see Pub. 505 to find out if you should
W-4 each year and when your personal or financial withholding allowances based on itemized adjust your withholding on Form W-4 or W-4P.
deductions, certain credits, adjustments to income,
situation changes. or two-earners/multiple jobs situations. Two earners or multiple jobs. If you have a
working spouse or more than one job, figure the
Exemption from withholding. If you are exempt, Complete all worksheets that apply. However, you total number of allowances you are entitled to claim
complete only lines 1, 2, 3, 4, and 7 and sign the may claim fewer (or zero) allowances. For regular on all jobs using worksheets from only one Form
form to validate it. Your exemption for 2017 expires wages, withholding must be based on allowances W-4. Your withholding usually will be most accurate
February 15, 2018. See Pub. 505, Tax Withholding you claimed and may not be a flat amount or when all allowances are claimed on the Form W-4
and Estimated Tax. percentage of wages. for the highest paying job and zero allowances are
Note: If another person can claim you as a dependent Head of household. Generally, you can claim head claimed on the others. See Pub. 505 for details.
on his or her tax return, you can’t claim exemption of household filing status on your tax return only if Nonresident alien. If you are a nonresident alien, see
from withholding if your total income exceeds $1,050 you are unmarried and pay more than 50% of the Notice 1392, Supplemental Form W-4 Instructions for
and includes more than $350 of unearned income (for costs of keeping up a home for yourself and your Nonresident Aliens, before completing this form.
example, interest and dividends). dependent(s) or other qualifying individuals. See Check your withholding. After your Form W-4 takes
Pub. 501, Exemptions, Standard Deduction, and effect, use Pub. 505 to see how the amount you are
Exceptions. An employee may be able to claim Filing Information, for information. having withheld compares to your projected total tax
exemption from withholding even if the employee is Tax credits. You can take projected tax credits into for 2017. See Pub. 505, especially if your earnings
a dependent, if the employee: account in figuring your allowable number of exceed $130,000 (Single) or $180,000 (Married).
• Is age 65 or older, withholding allowances. Credits for child or dependent

• Is blind, or care expenses and the child tax credit may be claimed Future developments. Information about any future
• Will claim adjustments to income; tax credits; or using the Personal Allowances Worksheet below. developments affecting Form W-4 (such as
itemized deductions, on his or her tax return. See Pub. 505 for information on converting your other legislation enacted after we release it) will be posted
credits into withholding allowances. at www.irs.gov/w4.

Personal Allowances Worksheet (Keep for your records.)

A Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A
{ }B Enter “1” if:
• You’re single and have only one job; or

• You’re married, have only one job, and your spouse doesn’t work; or ... B

• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more

than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D

E Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . E

F Enter “1” if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . . F

(Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

• If your total income will be less than $70,000 ($100,000 if married), enter “2” for each eligible child; then less “1” if you
have two to four eligible children or less “2” if you have five or more eligible children.

• If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter “1” for each eligible child. G

{H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) ▶ H
For accuracy, • If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
complete all and Adjustments Worksheet on page 2.
worksheets • If you are single and have more than one job or are married and you and your spouse both work and the combined
earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2
that apply. to avoid having too little tax withheld.

• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

W-4Form Employee’s Withholding Allowance Certificate OMB No. 1545-0074

Department of the Treasury ▶ Whether you are entitled to claim a certain number of allowances or exemption from withholding is 2017
Internal Revenue Service subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

1 Your first name and middle initial Last name 2 Your social security number

Home address (number and street or rural route) 3 Single Married Married, but withhold at higher Single rate.

Note: If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card,

check here. You must call 1-800-772-1213 for a replacement card. ▶

5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5
6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6$

7 I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption.

• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and

• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.

If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . ▶ 7
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

Employee’s signature Date ▶
(This form is not valid unless you sign it.) ▶ 9 Office code (optional) 10 Employer identification number (EIN)

8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2017)







Employment Eligibility Verification USCIS
Form I-9
Department of Homeland Security
U.S. Citizenship and Immigration Services OMB No. 1615-0047
Expires 08/31/2019

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,

during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which
document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ

an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later

than the first day of employment, but not before accepting a job offer.)

Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)

Address (Street Number and Name) Apt. Number City or Town State ZIP Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's E-mail Address Employee's Telephone Number
--

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States QR Code - Section 1
2. A noncitizen national of the United States (See instructions) Do Not Write In This Space

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):
Some aliens may write "N/A" in the expiration date field. (See instructions)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:

OR

2. Form I-94 Admission Number:

OR

3. Foreign Passport Number:

Country of Issuance:

Signature of Employee Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):

I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my

knowledge the information is true and correct.

Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State ZIP Code

Employer Completes Next Page

Form I-9 11/14/2016 N Page 1 of 3

Employment Eligibility Verification USCIS
Form I-9
Department of Homeland Security
U.S. Citizenship and Immigration Services OMB No. 1615-0047
Expires 08/31/2019

Section 2. Employer or Authorized Representative Review and Verification

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists
of Acceptable Documents.")

Employee Info from Section 1 Last Name (Family Name) First Name (Given Name) M.I. Citizenship/Immigration Status

List A OR List B AND List C
Identity and Employment Authorization Document Title Identity Employment Authorization
Document Title
Document Title

Issuing Authority Issuing Authority Issuing Authority
Document Number Document Number Document Number
Expiration Date (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy)

Document Title Additional Information QR Code - Sections 2 & 3
Issuing Authority Do Not Write In This Space
Document Number
Expiration Date (if any)(mm/dd/yyyy)

Document Title
Issuing Authority
Document Number
Expiration Date (if any)(mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,

(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the

employee is authorized to work in the United States.

The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)

Signature of Employer or Authorized Representative Today's Date(mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name

Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable) B. Date of Rehire (if applicable)

Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes
continuing employment authorization in the space provided below.

Document Title Document Number Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative

Form I-9 11/14/2016 N Page 2 of 3











Notes


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