Common use of CONTRACT CHANGE NOTICE Clause in Contracts

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditions, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBS, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phase, etc., including PSS-A2 and PSS-A8 forms) - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. - A CCN Form, as per the format below, signed by the Contractor’s representatives The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either party, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Officer and the Technical Officer of each party. DIRECTORATE: Contractor: Contract No.: CONTRACT CHANGE NOTICE No.: DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Contract No.: 4000XXXXXX/16/XX/XXX CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause Clause 13 of the General Conditions, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBS, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 PSS‑A2 and PSS-A8 PSS‑A8 forms) - The Milestone Payment Plan for the CCN if any Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. - .) A CCN Form, as per the format below, signed by the Contractor’s representatives The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor:   Contract No.:   CONTRACT CHANGE NOTICE No.: .   DATE:   TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC):   WP REF: MUP REF:   INITIATOR OF CHANGE:   DESCRIPTION OF CHANGE   REASON FOR CHANGE   PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS   START OF WORK   END OF WORK   CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING IHEALTH, [insert full name] an employee of [SAFETY AND SECURITY REGULATIONS (if applicable: in case the Contractor is requested to perform any activity on-site the ESA premises) For work on-site the Agency premises the following conditions apply: The Contractor and its personnel, shall adhere to the ESA Health, Safety and Security Regulations applicable at the respective ESA establishment. They shall be made available to the Contractor upon request. All Contractor’s name]personnel, assigned who need to carry out enter the Agency’s premises in order to render the work under this Contract, shall be issued with an identity card by the Agency. This card shall clearly identify the relevant persons as Contractor’s personnel. This card must be visibly carried by the personnel concerned on entering and leaving the Agency’s site and at all times, when personnel is present on the site. Identity cards must be immediately returned to the Agency, when personnel is replaced and on termination of the work rendered under the Contract. Upon the start of the WO, the Contractor shall supply to the Agency’s Technical Officer a complete list of all on-site personnel working under the WO and all relevant information to enable the Agency’s Technical officer to identify the personnel concerned. This list shall be countersigned by the Agency’s Technical Officer and any changes shall be notified to the Agency’s Technical Officer by the Contractor in connection writing five (5) working days before the change takes place. All visitors to the Contractor on an Agency site, including the Contractor’s personnel not working under this Contract, shall complete the formal visitor procedure at each site. Infringement of the regulations by the Contractor, its personnel or their visitors, will be notified in writing to the Contractor, who will take appropriate measures to ensure future compliance. In the event of serious infringements of the regulations, and in consultation with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “Contractor, the Contract”Agency may prohibit the entry onto this site(s) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract person or persons concerned. The consequences of such prohibition shall be considered without exception “borne by the Contractor. APPENDIX 6: ESA Unclassified – Proprietary Information”, hereby undertake as follows:POLICIES ON THE USE OF ESA COMMUNICATION FACILITIES (if applicable: in case the Contractor is requested to perform any activity on-site the ESA premises)

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Contract No.: 4000XXXXXX/17/XX/XXX/xx CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Comenius University in Bratislava Contract No.: 4000XXXXXX/19/NL/SC CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Contract No.: 4000XXXXXX/16/XX/XXX/xx CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his its proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in Euro (€), if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Contract No.: 4000XXXXXX/XX/XX/XX CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his its proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in Euro (€), if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Institute of Experimental Physics, of the Slovak Academy of Sciences Contract No.: 4000137046/22/NL/SC CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause Xxxxxx 13 of the General Conditions, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBS, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phase, etc., including PSS-A2 and PSS-A8 forms) - Effect on other Contract provisions - Start of work - – end of work (including contractual delivery dates and overall planning, milestones, etc. - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either party, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Officer and the Technical Officer of each party. DIRECTORATE: xxxxx Contractor: [Contractor Name] Contract No.: Xxxxxxx CONTRACT CHANGE NOTICE No.: DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: [Insert Name and Surname] DATE: CONTRACTOR’S CONTRACTS OFFICER: [Insert Name and Surname] DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: Xxxxxx Xxxx DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee 5 - STANDARD COVER PAGE FOR ESA STUDY CONTRACT REPORTS‌ ESA STUDY CONTRACT REPORT – SPECIMEN No ESA Study Contract Report will be accepted unless this sheet is inserted at the beginning of [Contractor’s name], assigned to carry out work in connection with each volume of the ESA/ESOC Report. ESA Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:: Xxxxxxx SUBJECT: CONTRACTOR: [Contractor Name]

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Contract No.: 4000XXXXXX/16/XX/XXX/xx CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows:

CONTRACT CHANGE NOTICE. For submission of a change as per clause 13 of the General Conditionschange, the Contractor shall submit his proposal in the format of a CCN using the cover page included below. The form shall be filled with the following information as a minimum: - The Contractor’s name and the Contract number - The title of the area affected by the change (Work Package reference, new work, etc.) - The name of the initiator of the change (Contractor or ESA) - The description of the change (including Work Package Descriptions, WBSWork Breakdown Structure, etc.) - The reason for the change - The price breakdown in €, if any (breakdown by company, phasePhase, etc., including PSS-A2 and PSS-A8 forms) - The Milestone Payment Plan for the CCN if any - Effect on other Contract provisions - Start of work - end of work (including contractual delivery dates and overall planning, milestones, etc. .) - A CCN Form, as per the format below, signed by the Contractor’s representatives representatives. The Contractor shall, on request of the Agency, provide additional documentary evidence. At the request of either partyParty, the proposed change may be discussed at a Change Review Board, consisting of both the Contract Contracts Officer and the Technical Officer of each partyParty. DIRECTORATE: Contractor: Contract No.: 4000XXXXXX/17/XX/XXX/xx CONTRACT CHANGE NOTICE No.: . DATE: TITLE OF AREA AFFECTED (WORK PACKAGE/MUP/PACKAGE ETC): WP REF: MUP REF: INITIATOR OF CHANGE: DESCRIPTION OF CHANGE REASON FOR CHANGE PRICE BREAKDOWN (Currency)/PRICE-LEVEL EFFECT ON OTHER CONTRACT PROVISIONS START OF WORK END OF WORK CONTRACTOR’S PROJECT MANAGER: DATE: CONTRACTOR’S CONTRACTS OFFICER: DATE: [DISPOSITION RECORD OR OTHER AGREED CONDITION RECORDED WITH THE CCN APPROVAL] ESA TECHNICAL OFFICER: DATE: ESA CONTRACTS OFFICER: DATE: APPENDIX 5: CONFIDENTIALITY UNDERTAKING MODEL CONFIDENTIALITY UNDERTAKING I, [insert full name] an employee of [Contractor’s name], assigned to carry out work in connection with the ESA/ESOC Contract No. 4000xxxxx/13/D/JR (hereinafter “the Contract”) having been informed that in accordance with the Contract, all data and information, to which I may be given access for the performance of my duties in the framework of the Contract, as well as all Work Results under the Contract shall be considered without exception “ESA Unclassified – Proprietary Information”, hereby undertake as follows: