0000899243-20-019997.txt : 20200722 0000899243-20-019997.hdr.sgml : 20200722 20200722135817 ACCESSION NUMBER: 0000899243-20-019997 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200722 FILED AS OF DATE: 20200722 DATE AS OF CHANGE: 20200722 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Afsari Nasym CENTRAL INDEX KEY: 0001817851 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39394 FILM NUMBER: 201041166 MAIL ADDRESS: STREET 1: 1 PARK PLAZA STREET 2: SUITE 1000 CITY: IRVINE STATE: CA ZIP: 92614 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Montrose Environmental Group, Inc. CENTRAL INDEX KEY: 0001643615 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT CONSULTING SERVICES [8742] IRS NUMBER: 464195044 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1 PARK PLAZA, SUITE 1000 CITY: IRVINE STATE: CA ZIP: 92614 BUSINESS PHONE: (949) 988-3500 MAIL ADDRESS: STREET 1: 1 PARK PLAZA, SUITE 1000 CITY: IRVINE STATE: CA ZIP: 92614 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-07-22 0 0001643615 Montrose Environmental Group, Inc. MEG 0001817851 Afsari Nasym 1 PARK PLAZA, SUITE 1000 IRVINE CA 92614 0 1 0 0 General Counsel and Secretary Common Stock 3175 D Stock Option (Right to Buy) 6.03 2026-06-23 Common Stock 156625 D Stock Option (Right to Buy) 5.72 2024-11-17 Common Stock 31250 D Stock Option (Right to Buy) 24.00 2029-01-10 Common Stock 20460 D Stock Option (Right to Buy) 31.60 2030-01-01 Common Stock 18892 D This option represents the fully-vested right to purchase a total of 156,625 shares of the Issuer's common stock, par value $0.000004 (the "Common Stock"). This option represents the fully-vested right to purchase a total of 31,250 shares of Common Stock. This option represents the right to purchase a total of 20,460 shares of Common Stock, 6,820 of which have vested, with the remaining shares vesting in two equal annual installments on January 10, 2021 and January 10, 2022, subject to the Reporting Person's continued service to the Issuer. This option represents the right to purchase a total of 18,892 shares of Common Stock which will vest in three equal annual installments on January 1, 2021, January 1, 2022, and January 1, 2023, subject to the Reporting Person's continued service to the Issuer. Exhibit 24.1 - Power of Attorney /s/ Nasym Afsari 2020-07-22 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT
                               POWER OF ATTORNEY

        Know all by these presents, that the undersigned hereby makes,
constitutes and appoints Allan Dicks and Maria Pitol signing singly, as the
undersigned's true and lawful attorney-in-fact, with full power and authority as
hereinafter described on behalf of and in the name, place and stead of the
undersigned to:

(1)     prepare, execute in the undersigned's name and on the undersigned's
        behalf, and submit to the U.S. Securities and Exchange Commission (the
        "SEC") a Form ID, including amendments thereto, and any other documents
        necessary or appropriate to obtain codes and passwords enabling the
        undersigned to make electronic filings with the SEC of reports required
        by Section 16(a) of the Securities Exchange Act of 1934 (the "Exchange
        Act") and the rules and regulations promulgated thereunder, as amended
        from time to time;

(2)     prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5
        (including any amendments thereto) with respect to the securities of
        Montrose Environmental Group, Inc., a Delaware corporation, or any
        successor thereto (the "Company"), with the SEC, any national securities
        exchanges and the Company, as considered necessary or advisable under
        Section 16(a) of the Exchange Act and the rules and regulations
        promulgated thereunder, as amended from time to time;

(3)     seek or obtain, as the undersigned's representative and on the
        undersigned's behalf, information of transactions in the Company's
        securities from any third-party, including brokers, employee benefit
        plan administrators and trustees, and the undersigned hereby authorizes
        any such person to release any such information to the undersigned and
        approves and ratifies any such release of information; and

(4)     perform any and all other acts which in the discretion of such attorney-
        in- fact is necessary or desirable for and on behalf of the undersigned
        in connection with the foregoing.

The undersigned acknowledges that:

(1)     this Power of Attorney authorizes, but does not require, such attorney-
        in- fact to act in his or her discretion on information provided to such
        attorney-in-fact without independent verification of such information;

(2)     any documents prepared and/or executed by such attorney-in-fact on
        behalf of the undersigned pursuant to this Power of Attorney will be in
        such form and will contain such information and disclosure as such
        attorney-in- fact, in his or her discretion, deems necessary or
        desirable;

(3)     neither the Company nor such attorney-in-fact assumes (i) any liability
        for the undersigned's responsibility to comply with the requirement of
        the Exchange Act, (ii) any liability of the undersigned for any failure
        to comply with such requirements, or (iii) any obligation or liability
        of the undersigned for profit disgorgement under Section 16(b) of the
        Exchange Act; and

(4)     this Power of Attorney does not relieve the undersigned from
        responsibility for compliance with the undersigned's obligations under
        the Exchange Act, including without limitation the reporting
        requirements under Section 16 of the Exchange Act.

        The undersigned hereby gives and grants the foregoing attorney-in-fact
full power and authority to do and perform all and every act and thing
whatsoever requisite, necessary or appropriate to be done in and about the
foregoing matters as fully to all intents and purposes as the undersigned might
or could do if present, hereby ratifying all that such attorney-in-fact of, for
and on behalf of the undersigned, shall lawfully do or cause to be done by
virtue of this Power of Attorney.

        This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of, and transactions in, securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing delivered
to the foregoing attorney-in-fact.

        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this 9th day of December, 2019.

                                        By:    /s/ Nasym Afsari
                                               -------------------------------
                                        Name:  Nasym Afsari
                                        Title: General Counsel and Secretary