Institution Statement of Agreement Sample Contracts

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Institution Statement of Agreement • September 8th, 2016

INSTITUTION STATEMENT OF AGREEMENT SMLOUVA SE ZDRAVOTNICKÝM ZAŘÍZENÍM PROTOCOL # ICL-24-ABSSSI2 PROTOKOL Č. ICL-24-ABSSSI2 ACCOUNT # 8323859 SITE # 245001 ÚČET Č.: 8323859 PRACOVIŠTĚ Č.: 245001 1. INTRODUCTION 1. ÚVOD This agreement (this “Agreement”) is between Covance Inc. (hereafter known as “Covance”) a company located at 210 Carnegie Center, Princeton, New Jersey, 08450-6233, USA, a Contract Research Organisation acting as an agent for Motif BioSciences, Inc 125 Park Avenue, 25th Floor, Suite 2622, New York, NY 10017, United States, (the “Sponsor”) and Krajská zdravotní, a.s. (“Institution”), whose principal place of business is Sociální péče 3316/12A, 400 11 Ústí nad Labem, Czech Republic. Tato smlouva (dále jen „smlouva“) se uzavírá mezi společností Covance Inc. (dále jen„Covance“) se sídlem 210 Carnegie Center, Princeton, New Jersey, 08450-6233, USA, smluvní výzkumnou organizací, která jedná jako zástupce společnosti Motif BioSciences, Inc, 125 Park Avenue, 25th

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