SIGNATURES BEGIN ON NEXT PAGE. The Parties have executed this Agreement by their respective duly authorized representatives on the day and year below. Any communication or notice to be given shall be forwarded in writing to the respective addresses listed below. FOR PROVIDER _____________________________________ __________________ Xxxxx Xxxx, MBA Date Technology Development Coordinator Division of Medications Development _____________________________________ Xxxx X. Xxxxxx, Ph.D. Acting Director, Division of Medications Development NIAAA Mailing Address for Notices: NIAAA Xxxxx Xxxx 0000 Xxxxxxx Xxxx, 0000 Xxxxxxxx, XX 00000 (000) 000-0000 xxxxx0@xxxx.xxx.xxx FOR RECIPIENT: ____________________________________ __________________ (Signature of Authorized Representative) Date Name Title Mailing Address for Notices: Email: Phone: RECIPIENT’s INVESTIGATOR: I have read and understood the terms and conditions of this Agreement and I will abide by them in the receipt and use of this Clinical Data. _____________________________________ __________________ Name: Date Address: Email: Phone:
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SIGNATURES BEGIN ON NEXT PAGE. For the IC: NIH PATENT LICENSE AGREEMENT NONEXCLUSIVE - SUBLICENSABLE SIGNATURE PAGE DRAFT Name Date Title Office National Institutes of Health Mailing Address or E-mail Address for Agreement notices and reports: License Compliance and Administration Monitoring & Enforcement Office of Technology Transfer National Institutes of Health 0000 Xxxxxxxxx Xxxxxxxxx, Xxxxx 000 Xxxxxxxxx, Xxxxxxxx 00000-0000 X.X.X. E-mail: XxxxxxxXxxxxxx_Xxxxxxx@xxxx.xxx.xxx For the Licensee (Upon, information and belief, the undersigned expressly certifies or affirms that the contents of any statements of the Licensee made or referred to in this document are truthful and accurate.): by: DRAFT Signature of Authorized Official Date Printed Name Title
SIGNATURES BEGIN ON NEXT PAGE. Third Amendment of [***] Model 10-2015 [***] [Final] [Icosavax, Inc.] [May 2023] THIRD AMENDMENT TO [***] In Witness Whereof, the parties have executed this Third Amendment on the dates set forth below. Any communication or notice to be given shall be forwarded to the respective addresses listed below. For the NIAID: /s/ Xxxxxxx X. Xxxxxx, Ph.D. 2023.05.23 Xxxxxxx X. Xxxxxx, Ph.D. Date Director Technology Transfer and Intellectual Property Office National Institute of Allergy and Infectious Diseases National Institutes of Health Mailing Address or E-mail Address for Agreement notices and reports: License Compliance and Administration Monitoring & Enforcement Office of Technology Transfer National Institutes of Health 0000 Xxxxxxxxx Xxxxxxxxx, Xxxxx 000 Xxxxxxxxx, Xxxxxxxx 00000-3804 U.S.A.
