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The Americans with Disabilities Act (ADA) prohibits discrimination against disabled individuals across a very broad spectrum. In the area of employment, the act prohibits discrimination against a qualified individual with a disability with regard to his or her terms and conditions of employment. The broad scope of the ADA means that acquirers and those engaged in securities offerings need to conduct ADA-specific due diligence, focused on the particular circumstance. Name of Target Company: _________________ Name of Diligence Attorney: ________________ Date: ___________ Name of HR Director or Other Person Interviewed: ______________ It is important to determine, on a preliminary basis, the Target Company’s level of compliance with the ADA and its risk profile in that regard. Please review the following information that was derived from Target Company records and an interview with _________________, HR Director, and then let’s discuss the next steps. 1. Is the Target covered by ADA? Yes _____ No _____ Comments: 2. Total number of employees: 3. Number of employees currently on leave of absence for any medical reason, including sickness, or a mental or physical impairment: Comments: 4. Indicate known types of impairments: _____ infectious diseases _____ neurological disorders _____ disfigurement _____ anatomical loss _____ bodily systems (e.g., sense organs, respiratory, cardiovascular, lymphatic, etc.) _____ mental impairment (e.g., learning disabilities, emotional or mental illness, organic brain syndrome, etc.) _____ chronic conditions (e.g., HIV, cancer, diabetes, multiple sclerosis, etc.) _____ other (describe). 5. Does the company currently have an ADA compliance policy? Yes _____ No _____ 6. Does the company currently monitor ADA compliance? Yes _____ No _____ Comments: 7. Name and Contact Information of Principal Responsible Officer for ADA related issues: __________________ 8. How many employees does the company currently accommodate because of any type of impairment? ____ Describe how such accommodations are implemented and managed: 9. For each accommodated impairment, describe the character, extent and duration of such accommodation. 10. Is the company currently discussing and/or considering possible accommodations for any employees? _____ If so, how many? _____ 11. Have any ADA-related complaints by employees been registered with the company? Yes _____ No _____ Comments: 12. In a separate attachment, please describe each ADA-based complaint. 13. Has the company ever been the subject of a charge of discrimination filed with the Equal Employment Opportunity Commission (or a state agency) or a law suit based on a claim of discrimination under the ADA? Yes _____ No _____ If yes, please describe and attach relevant details: 14. Does the company use employee testing or screening procedures? Yes _____ No _____ 15. If yes, describe the types of tests used, utilization history, scoring procedures and other relevant data: 16. Has the company ever been the subject of a discrimination claim based on its testing procedures or results? Yes _____ No _____ If yes, please describe and attach relevant details: 17. Does the company employ drug use testing procedures? Yes _____ No _____ If yes, please describe: 18. Please provide an overall assessment of your views of the company’s ADA policies and practices. Include suggestions as to any further due diligence that you would recommend:

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