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Debris Removal (additional amount) | Debris Removal | Debris Removal |
Tenant agrees that all signs, awnings, protective gates, security devices and other installations visible from the exterior of the Premises shall be subject to Landlord's prior written approval, shall be subject to the prior approval of the Landmarks Preservation Commission of the City of New York, if required, and shall not interfere with or block either of the adjacent stores, provided, however, that Landlord shall not unreasonably withhold consent for signs that Tenant desires to install. Tenant agrees that any permitted signs, awnings, protective gates, security devices, and other installations shall be installed at Tenant’s sole cost and expense professionally prepared and dignified and subject to Landlord's prior written approval, which shall not be unreasonably withheld, delayed or conditioned, and subject to such reasonable rules and restrictions as Landlord from time to time may impose. Tenant shall submit to Landlord drawings of the proposed signs and other installations, showing the size, color, illumination and general appearance thereof, together with a statement of the manner in which the same are to be affixed to the Premises. Tenant shall not commence the installation of the proposed signs and other installations unless and until Landlord shall have approved the same in writing. . Tenant shall not install any neon sign. The aforesaid signs shall be used solely for the purpose of identifying Tenant's business. No changes shall be made in the signs and other installations without first obtaining Landlord's prior written consent thereto, which consent shall not be unreasonably withheld, delayed or conditioned. Tenant shall, at its own cost and expense, obtain and exhibit to Landlord such permits or certificates of approval as Tenant may be required to obtain from any and all City, State and other authorities having jurisdiction covering the erection, installation, maintenance or use of said signs or other installations, and Tenant shall maintain the said signs and other installations together with any appurtenances thereto in good order and
condition and to the satisfaction of the Landlord and in accordance with any and all orders, regulations, requirements and rules of any public authorities having jurisdiction thereover. Landlord consents to Tenant’s Initial Signage described in annexed Exhibit D.
Upon the expiration or termination of the term of this Lease, the Tenant shall remove all signs and other installations installed by Tenant, if any, at its sole cost and expense and shall, at its sole cost and expense, repair any damage to the Building caused by the installation or removal of any such signs or other installations and restore the Building to a satisfactory condition to make it as if no sign or other installations had been placed thereon. In the event that the Tenant violates any of the provisions of this Article, the Landlord may remove the subject items without any liability to the Tenant and may charge the Tenant all of the Landlord’s costs and expenses incurred in connection with the removal and disposal of such items, and the repair of the part of the Building to which such items were attached.
In order to maintain the highest standards of appearance, character and dignity for the Building, no paper or other signs shall be placed on the windows or exterior of the Premises or shall be placed in the Premises so that they can be seen from the outside of the Premises unless the same are tastefully and professionally prepared and approved by Landlord. | Signage Requirements | Signage and Signage Requirements |
PRESENTED BY
PROPOSED ON 05/14/2021 FOR
InsA LLC
NO1 REAL ESTATE INC.
Street 1, SUITE 100
Road 2, SUITE 400
City, State, Zip Code
City, State, Zip Code
On behalf of INSA LLC and The InsuranceA Indemnity Company and its Affiliates*, we appreciate the opportunity to provide NO1 REAL ESTATE INC. with the ollowing policy proposal.
InsuranceA Risk Control: Our Expertise is Your Advantage
InsuranceA Risk Control is an innovative provider of cost-effective risk management services and products. As one of the largest Risk Control departments in the industry, our scale allows the right resource at the right time to meet customer needs. For over 110 years, our loss prevention professionals have assisted agents, brokers and customers across the country and around the world.
https://www.InsuranceA.com/risk-control
Claim Services:
InsuranceA has over 11,000 highly trained Claim professionals located across the
U.S. Our local field representatives are supported by teams of dedicated customer service, catastrophe response, legal, medical, investigative, engineering, and large loss experts. Technology claims can be complex and expensive. We’ll help you manage claims to control your total risk-related costs.
https://www.InsuranceA.com/claims
Commercial Property Program
Policy Number
Y-630-001
Effective
05/29/2021 – 05/29/2022
Insuring Company
THE INSURANCEA INDEMNITY COMPANY
Automobile
Policy Number
BA-001
Effective
05/29/2021 – 05/29/2022
Insuring Company
THE INSURANCEA INDEMNITY COMPANY OF AMERICA
Umbrella
Policy Number
CUP-001
Policy Term
05/29/2021 – 05/29/2022
Insuring Company
INSURANCEA PROPERTY CASUALTY COMPANY OF AMERICA
Locations schedule
630 - 001 – Commercial Property Program
LOC/BLDG
DESCRIPTION
ADDRESS
1/1
OFFICE
STE 400, HOUSTON, TX, 77042
2/2
OFFICE
Ave, HOUSTON, TX, 77042
3/3
VACANT BLDG
AVE, HOUSTON, TX, 77042
3/4
PARKING GARAGE
AVE, HOUSTON, TX, 77042
4/5
OFFICE
AVE, HOUSTON, TX, 77042
4/6
PARKING GARAGE
AVE, HOUSTON, TX, 77042
5/7
OFFICE
AVE, HOUSTON, TX, 77082
6/8
OFFICE
AVE, BLDG 1, HOUSTON, TX, 77082
6/9
PARKING GARAGE
AVE, BLDG 2, HOUSTON, TX, 77082
7/10
OFFICE
AVE, HOUSTON, TX, 77082
8/11
OFFICE
FRWY, BLDG 1, HOUSTON, TX, 77036
8/12
PARKING GARAGE
FRWY, BLDG 2, HOUSTON, TX, 77036
8/13
DRIVE THRU BANK
FRWY, BLDG 3, HOUSTON, TX, 77036
9/14
OFFICE
DR, BLDG 1, HOUSTON, TX, 77082
9/15
PARKING GARAGE
DR, BLDG 2, HOUSTON, TX, 77082
10/16
OFFICE
RD, SPRING, TX, 77380
11/17
OFFICE
RD, SPRING, TX, 77380
12/18
OFFICE
FRWY, SPRING, TX, 77379
13/19
OFFICE
18311-18419, SPRING, TX, 77379
14/20
OFFICE
RD, HOUSTON, TX, 77082
Policy Number
630-001
Coverages and limits of insurance – described premises
Insurance applies on a BLANKET basis only to a coverage or type of property for which a Limit of Insurance is shown below, and then only at the premises locations for which a value for such coverage or property is shown on the Statement of Values dated 6/24/2021 , or subsequently reported to and insured by us. For Insurance that applies to a specific premises location see Deluxe Property Coverage Part Schedule - Specific Limits
BLANKET DESCRIPTION OF COVERAGE OR PROPERTY
LIMITS OF INSURANCE
Buildings
$111,158,795
Co-insurance provision
Coinsurance does not apply to Blanket Coverages shown above.
Valuation provision
Replacement cost (subject to limitations) applies to most types of covered property (See Valuation Loss Condition).
Deluxe property coverage part schedule - specific limits - described premises
Insurance applies only to a premises location and building number and to a coverage or type of property for which a Specific Limit of Insurance is shown on schedule.
Co-insurance provision
Coinsurance does not apply to any Building,Personal Property or “Stock” coverage for which a Specific Limit of Insurance applies as shown on schedule.
Valuation provision
Replacement cost (subject to limitations) applies to most types of covered property (See Valuation Loss Condition).
Additional covered property
Personal Property at Undescribed Premises
LIMITS OF INSURANCE
At any “exhibition” premises
Not Covered
At any installation premises or temporary storage premises
Not Covered
At any other not owned, leased or regularly operated premises
$25,000
Personal Property in Transit
$25,000
Deluxe property coverage form - additional coverages & coverage extensions
The Limits of Insurance shown in the left column are included in the coverage form and apply unless a Revised Limit of Insurance or Not Covered is shown in the Revised Limits of Insurance column on the right. The Limits of Insurance apply in any one occurrence unless otherwise stated.
LIMITS OF INSURANCE
REVISED LIMITS OF INSURANCE
Accounts Receivable:
At all described premises
$50,000
In transit or at all undescribed premises
$25,000
Appurtenant Buildings and Structures
$100,000
Claim Data Expense
$25,000
Covered Leasehold Interest – Undamaged Improvements & Betterments
Lesser of Your Business Personal Property limit or:
$100,000
Debris Removal (additional amount)
$250,000
Deferred Payments
$25,000
Duplicate Electronic Data Processing Data and Media
$50,000
Electronic Data Processing Data and Media
At all described premises
$50,000
Employee Tools
In any one occurrence
$25,000
Any one item
$2,500
Expediting Expenses
$25,000
Extra Expense
$25,000
Fine Arts
At all described premises
$50,000
In transit
$25,000
Fire Department Service Charge
Included*
Fire Protective Equipment Discharge
Included*
Green Building Alternatives – Increased Cost
Percentage 1%
Maximum amount – each building
$100,000
Green Building Reengineering and Recertification Expense
$25,000
Limited Coverage for Fungus, Wet Rot or
Dry Rot – Annual Aggregate
$25,000
Loss of Master Key
$25,000
Newly Constructed or Acquired Property:
Buildings - each
$2,000,000
Personal Property at each premises
$1,000,000
• means included in applicable Covered Property Limit of Insurance
Deluxe property coverage form - additional coverages & coverage extensions
LIMITS OF INSURANCE
REVISED LIMITS OF INSURANCE
Non-Owned Detached Trailers
$25,000
Ordinance or Law Coverage
$250,000
$1,000,000
Outdoor Property
$25,000
Any one tree, shrub or plant
$2,500
Outside Signs
At all described premises
$100,000
At all undescribed premises
$5,000
Personal Effects
$25,000
Personal Property At Premises Outside of the Coverage Territory
$50,000
Personal Property In Transit Outside of the Coverage Territory
$25,000
Pollutant Cleanup and Removal – Annual Aggregate
$100,000
Preservation of Property
Expenses to move and temporarily store property
$250,000
Direct loss or damage to moved property
Included*
Reward Coverage
25% of covered loss up to a maximum of:
$25,000
Stored Water
$25,000
Theft Damage to Rented Property
Included*
Undamaged Parts of Stock in Process
$50,000
Valuable Papers and Records – Cost of Research
At all described premises
$50,000
In transit or at | InsuranceA Risk Control Proposal | Policy Proposal Details |
are on stable prandial insulin and basal insulin (neutral protamine Hagedorn [NPH] insulin, insulin glargine or insulin detemir) for at least 3 months before screening with a total insulin dose demand of ≤1.5 U/kg/day | Eligibility Criteria | Inpatient Dosing Days Exclusion Criteria |
Family History:
Patient's Dad died of liver cirrhosis at age 57, mom died of heart attack at age 60. She has 6 siblings who most died of cardiac disease. There is no family history of cancer. | Cardiac Disease Family History | Family History |
This lease shall be construed in accordance with and governed by the internal laws (without reference to choice or conflict of laws) of the State of New York. In respect of any dispute between the parties regarding the subject matter hereof, the parties hereby irrevocably consent and submit to in personam jurisdiction in the courts of New York, located in the county in which the Building is located, including the United States courts located in said county, and to all proceedings in such courts. The parties hereby agree that such courts shall be the venue and exclusive and proper forum in which to adjudicate any case or controversy arising either, directly or indirectly, under or in connection with this lease and that they will not contest or challenge the jurisdiction or venue of these courts. | Jurisdiction | Governing Law |
economic, military, financial, regulatory, political, terrorist and other events that affect securities generally;
interest and yield rates in the market;
the time remaining until a note matures; and
our creditworthiness. As a result of these and other factors, if you sell your note prior to maturity, you may receive less than the accreted value of your note. Moreover, these factors interrelate in complex ways, and the effect of one factor may offset or enhance the effect of another factor. | Market Factors Affecting Note Value | Risk Factors |
Each Party shall cooperate with the other Party in promptly reviewing, investigating and resolving any written, electronic, or oral communication that alleges deficiencies related to the identity, quality, durability, reliability, safety, effectiveness, or performance of Products or any other “complaint” within the meaning of the U.S. Food and Drug Administration regulations governing medical devices, in each case to the extent related to Products purchased hereunder (“Complaints”). | Complaint Resolution | Cooperation with US FDA Regulations |
Tenant expressly covenants that Tenant shall not voluntarily or involuntarily assign, encumber, mortgage or otherwise transfer this Lease, or sublet the Premises or any part thereof, or suffer or permit the Premises or any part thereof to be used or occupied by others, by operation of law or otherwise, without the prior written consent of Landlord in each instance, which consent shall not be unreasonably withheld or delayed. or conditioned. Absent such consent, any act or instrument purporting to do any of the foregoing shall be null and void. | No Assignment | No Assignment |
In the event that the Premises are not surrendered at the end of the Lease term, Tenant shall indemnify and save Landlord harmless against all costs, claims, loss, or liability resulting from delay by Tenant in so surrendering the Premises, including, without limitation, any claims made by any succeeding tenant founded on such delay. | Surrender Delay Indemnification | Surrender of Premises |
Administrative Information
Investigator In Charge (IIC):
David C Bowling
Additional Participating Persons:
Karsten Severin; German BFU
Investigation Docket:
NTSB accident and incident dockets serve as permanent archival information for the NTSB’s investigations. Dockets released prior to June 1, 2009 are publicly available from the NTSB’s Record Management Division at pubinq@ntsb.gov, or at 800-877-6799. Dockets released after this date are available at http://dms.ntsb.gov/pubdms/. | Administrative Details | Investigation Details |
It is unlikely that the patient has edema caused by abscess or tonsillitis since she does not have any associated fever or other signs of infection and the sudden onset of her swelling also argues against this. It is not likely a foreign body since ENT did not find anything when they scoped her. | No Infection/Foreign Body | Cause of Swelling |
PREMISES
BUILDINGS
LOCATION NO.
No.
2-13
2-19
the following percentage applies: | Building Location Percentages | Building and Building Location |
12.2.1 Preexisting Intellectual Property. Except for rights expressly granted under this agreement, each party will retain exclusive interest in and ownership of its Intellectual Property developed before this agreement or developed outside the scope of this agreement.
12.2.2 Independently Developed Intellectual Property. Any Intellectual Property developed solely by a party under this agreement without the participation of the other party is and will remain the sole and exclusive property of the developing party. | Intellectual Property Ownership | Independently Developed Intellectual Property |
At the following described premises:
PREMISES
BUILDINGS
LOCATION NO.
No.
2-13
2-19
the following percentage applies: | Premises Percentage | Casualty Damage and Restoration |
CRD is in the business of distributing pharmaceutical products to wholesalers, specialty distributors, physicians, clinics, hospitals, retail pharmacies, and other health care providers in the Territory, and of providing Information Systems and other services that support its customers’ use of its distribution capabilities (collectively, the “Services”). | Business Description | Services Provided |
Subject to the terms and conditions contained elsewhere in this Lease, Tenant’s use of the basement shall not, in any way, block Landlord's use of same, or interfere with any machinery or equipment in the basement. Tenant agrees that its use of the basement shall be in accordance with reasonable rules and regulations to be established by Landlord. | Basement Use | Basement Use |
All fixed rent and additional rent (collectively hereinafter referred to as "rent") shall be paid in such coin or currency (or, subject to collection, by good check payable in such coin or currency) of the United States of America as at the time shall be legal tender for the payment of public and private debts, at the office of Landlord as set forth above, or at such place and to such person as Landlord from time to time may designate. | Payment of Rent | Rent Payment Terms |
If applicable for the then-current use of the Demised Premises, Tenant shall install and maintain grease traps and/or grease interceptors, if and as required by all governmental and quasi- governmental authorities and all insurance regulations and insurance carrier requirements, to handle waste, including grease, oil or any material whatsoever which could damage, obstruct or overload any drainage, sewer or other system. Tenant shall maintain exhaust ducts to ensure proper ventilation of the Demised Premises as required by all governmental and quasi-governmental authorities and all insurance regulations and insurance carrier requirements. | Grease Traps/Interceptors and Exhaust | Grease Trap and Ventilation Requirements |
may be subject to redemption at the option of The Goldman Sachs Group, Inc. or repayment at the option of the holder | Redemption or Repayment Option | Redemption and Payments |
In no event shall Tenant be entitled to make, nor shall Tenant make, any claim, and Tenant hereby waives any claim, for money damages (nor shall Tenant claim any money damages by way of set-off, counterclaim or defense) based upon any claim or assertion by Tenant that Landlord has unreasonably withheld or delayed its consent or approval to any request of Tenant in such instances, if any, where Landlord is expressly required hereunder, or under law, not to unreasonably withhold or delay such consent. Tenant's sole remedy shall be an action or proceeding to enforce any such provision, or for specific performance, injunction or declaratory judgment. | Waiver of Money Damages | Unreasonable Withholding or Delay |
DESCRIPTION
FORM NUMBER
TEXAS CHANGES
CG 01 03 06 06
EXCLUSION - DISCRIMINATION
CG D1 42 02 19
AMEND-NON CUMULATION OF EACH OCC
CG D2 03 12 97
FUNGI OR BACTERIA EXCLUSION
CG D2 43 01 02
ADD'L INSURED-MORTGAGEE,ASSIGNEE,
CG D3 25 01 04
TOTAL AGGR LIMIT & DESIG LOC AGGR LIMIT
CG D3 74 02 19
AMEND CONTRAC LIAB EXCL-EXC TO NAMED INS
CG D4 21 07 08
XTEND ENDORSEMENT FOR SERVICE INDUSTRIES
CG D4 67 02 19
EXCL-VIOLATION OF CONSUMER FIN PROT LAWS
CG D6 18 10 11
TX CHANGES-EMPL-RELATED PRACTICES EXCL
CG F2 68 02 19
COMM'L GENERAL LIABILITY DEC
CG T0 01 11 03
DECLARATIONS PREMIUM SCHEDULE
CG T0 07 09 87
KEY TO DECLARATIONS PREMIUM SCHEDULE
CG T0 08 11 03
EMPLOYEE BENEFITS LIAB COV PART DEC
CG T0 09 09 93
TABLE OF CONTENTS - COM GEN LIAB COV
CG T0 34 02 19
EMPLOYEE BENEFITS LIAB TABLE OF CONTENTS
CG T0 43 01 16
COMMERCIAL GENERAL LIABILITY COV FORM
CG T1 00 02 19
EMPLOYEE BENEFITS LIABILITY COV FORM
CG T1 01 01 16 | Agreement Description | Declarations |
with history of prolapse. Musculo Skeletal - no changes in strengths, no joint tenderness or swelling Neurologic - No changes in memory Psychology - No changes in mood Heme/Lymph - Denies easy bruising | Musculoskeletal and Neurologic Exam | Musculoskeletal Exam Findings |
1. Deliverables. Company shall provide Client with software, technical support, product management, development, and testing services (“Services”) to the Client as described on one or more Statements of Work signed by Company and Client that reference this Agreement (“SOW” or “Statement of Work”). Company shall perform Services in a prompt manner and have the final product or service (“Deliverable”) ready for Client no later than the due date specified in the applicable SOW (“Completion Date”). This due date is subject to change in accordance with the Change Order process defined in the applicable SOW. Client shall assist Company by promptly providing all information requests known or available and relevant to the Services in a timely manner. | Deliverables | Deliverables |
In lieu of providing the insurance coverages described above and with the express approval of Shipper’s Risk Management Department, Carrier may furnish evidence of its authorization to self-insure. | Self-Insurance Option | Self-Insurance Coverage |
Tenant shall pay to Landlord, as additional rent, an amount equal to Tenant's Share of the amount by which Taxes for any Escalation Year during the term of this Lease exceed the Base Year Taxes. | Tax Escalation Payment | Tax Payment |
3.1 General. Tenant shall continuously use and occupy the Premises only for the Permitted Use of the Premises to the extent not prohibited by the Rules and Regulations. Tenant shall not use or permit or suffer the use of the Premises for any other business or purpose. Tenant shall conform to the Rules and Regulations. "Rules and Regulations" shall mean the rules and regulations for the Project promulgated by Landlord from time to time. The Rules and Regulations which apply as of the Date of this Lease are attached as EXHIBIT "D". | Permitted Use | Permitted Use |
63. End of Term
In the event that the Premises are not surrendered at the end of the Lease term, Tenant shall indemnify and save Landlord harmless against all costs, claims, loss, or liability resulting from delay by Tenant in so surrendering the Premises, including, without limitation, any claims made by any succeeding tenant founded on such delay.
Additionally, the parties recognize and agree that other damage to Landlord resulting from any failure by Tenant to timely surrender the Premises will be substantial, will exceed the amount of monthly rent theretofore payable hereunder, and will be impossible of accurate measurement. Tenant therefore agrees that if possession of the Premises is not surrendered to Landlord within one (1) day after the date of the expiration or sooner termination of the term of this Lease, then Tenant will pay Landlord as liquidated damages for each month and for each portion of any month during which Lessee holds over in the Premises after the expiration of the term of this Lease, a sum equal to one and one-half (1.5) times the average rent and additional rent which was payable per month under this Lease during the last six months of the term thereof, which sum Tenant agrees to pay to Landlord upon demand, in full, without set-off or deduction, and which sum Tenant agrees is fair and reasonable and does not constitute a penalty. (“Holdover Use and Occupancy”).
Nothing contained in this clause shall be construed to mean that the Landlord has given permission for Tenant or anyone else who occupies the Premises to remain on the Premises as a monthly Tenant, or as a Tenant from month to month and the Landlord may proceed to evict the Tenant as a "Holdover." Neither the billing nor the collection of use and occupancy in the above amount shall be deemed a waiver of any right of the Landlord to collect damages for Tenant's failure to vacate the Premises after the expiration or sooner termination of this Lease. If Tenant holds over in possession after the expiration or sooner termination of the term of this Lease, such holding over shall not be deemed to extend the term or renew the Lease, but such holding over thereafter shall continue upon the covenants and conditions herein set forth in the Lease. The aforesaid obligations shall survive the expiration or sooner termination of the term of this Lease.
In the event that on the date the Landlord repossesses the Premises under any provision of this Lease or upon the termination of this Lease or upon the expiration of the demised term, whichever is earlier, there remains within the Premises any property belonging to the Tenant said property shall be deemed to have been abandoned by the Tenant, at which time the Landlord may remove said property and dispose of said property in any manner as it deems fit, without any liability whatsoever.
In the event that the Premises are not surrendered at the end of the Lease term, Tenant shall indemnify Landlord against loss or liability resulting from Tenant's delay in surrendering the Premises thereafter until said Premises are surrendered. | End of Term | Holdover Indemnification |
Tenant covenants and agrees, at its sole cost and expense, to comply with all present and future Requirements regarding the collection, sorting, separation, and recycling of waste products, garbage, refuse and trash. Tenant shall sort and separate such waste products, garbage, refuse and trash into such categories as provided by law. Each separately sorted category of waste products, garbage, refuse and trash shall be placed in separate receptacles reasonably approved by Landlord and/or the Controlling Governmental agency(ies). Such separate receptacles may, at Landlord's option, be removed from the demised Premises in accordance with a collection schedule prescribed by law. | Waste Sorting and Recycling | Waste Products and Recycling |
Germany
This report is for informational purposes only and contains only information released by, or obtained from, the BFU of Germany.
Page 1 of 3
Pilot Information
Certificate:
Age:
Airplane Rating(s):
Seat Occupied:
Other Aircraft Rating(s):
Restraint Used:
Instrument Rating(s):
Second Pilot Present:
Instructor Rating(s):
Toxicology Performed:
Medical Certification:
Last FAA Medical Exam:
Occupational Pilot:
Last Flight Review or Equivalent:
Flight Time:
Aircraft and Owner/Operator Information
Aircraft Make:
Cirrus Design Corp.
Registration:
N141CD
Model/Series:
SR-20
Aircraft Category:
Airplane
Year of Manufacture:
Amateur Built:
No
Airworthiness Certificate:
Serial Number:
Landing Gear Type:
Seats:
Date/Type of Last Inspection:
Certified Max Gross Wt.:
Time Since Last Inspection:
Engines:
Airframe Total Time:
Engine Manufacturer:
ELT:
Engine Model/Series:
Registered Owner:
Rated Power:
Operator:
Operating Certificate(s) Held:
None
Meteorological Information and Flight Plan
Conditions at Accident Site:
Instrument Conditions
Condition of Light:
Observation Facility, Elevation:
Distance from Accident Site:
Observation Time:
Direction from Accident Site:
Lowest Cloud Condition:
Visibility
Lowest Ceiling:
Visibility (RVR):
Wind Speed/Gusts:
/
Turbulence Type Forecast/Actual:
/
Wind Direction:
Turbulence Severity Forecast/Actual:
/
Altimeter Setting:
Temperature/Dew Point:
Precipitation and Obscuration:
Departure Point:
Type of Flight Plan Filed:
Unknown
Destination:
Jaleg, UN
Type of Clearance:
Departure Time:
Type of Airspace:
Airport Information
Airport:
Runway Surface Type:
Airport Elevation:
Runway Surface Condition:
Runway Used:
IFR Approach:
Runway Length/Width:
VFR Approach/Landing:
Wreckage and Impact Information
Crew Injuries:
1 Fatal
Aircraft Damage:
Substantial
Passenger Injuries:
N/A
Aircraft Fire:
Ground Injuries:
N/A
Aircraft Explosion:
Total Injuries:
1 Fatal
Latitude, Longitude:
Administrative Information
Investigator In Charge (IIC):
David C Bowling
Additional Participating Persons:
Karsten Severin; German BFU
Investigation Docket:
NTSB accident and incident dockets serve as permanent archival information for the NTSB’s investigations. Dockets released prior to June 1, 2009 are publicly available from the NTSB’s Record Management Division at pubinq@ntsb.gov, or at 800-877-6799. Dockets released after this date are available at http://dms.ntsb.gov/pubdms/. | Pilot and Aircraft Information | Pilot and Aircraft Information |
(a) Not to cause, create or permit any fumes, vapors, or odors or permit the same to escape from the demised Premises into any other portion of the Building or the outside of the Building; and
(b) Not to constitute a public or private nuisance.
If Tenant installs and/or utilizes cooking equipment on the Premises: | No Fumes or Nuisance | Cooking Equipment and Use |
(ii) Use, or permit to be used, any advertising medium and/or loudspeaker, and/or sound amplifier, and/or radio or television broadcast which may be heard outside the Demised Premises or which does not comply with the general policies or rules and regulations then in effect for the Building; | No Nuisance | No Advertising |
Where any Confidential Information of the Disclosing Party is the subject of any national or governmental security regulations, the Receiving Party shall, and hereby undertakes to, take such measures as may be required by such regulations to protect such Confidential Information. Without prejudice to any obligations imposed on and assumed by the Receiving Party under any national or governmental security regulations, the obligations of confidentiality herein shall not apply to any Information which the Receiving Party by its written records can show: | National Security Regulations | Confidentiality of Arbitration |
Zocor (simvastatin) 40 mg po qHS | Medication Prescription | Medication Use Eligibility Criteria |
Business Income from Dependent Property | Business Income from Dependent Property | Dependent Property Income |
Suffer, allow or permit any offensive or obnoxious vibration, noise, odor or other undesirable effect to emanate from the Demised Premises, or any machine or other installation therein, or otherwise suffer, allow or permit the same to constitute a nuisance (it shall be the Tenant's obligation to install insulation and/or sound deadening devices as necessary to prevent any such vibration, noise, odor or other undesirable effect). | Nuisance Prevention | No Nuisance |
Protocol I8B-MC-ITRV(b) A Study to Evaluate the Pharmacokinetics and Glucodynamics of LY900014 compared to Humalog® in | Protocol Description | Study Protocol |
Covered Auto Symbols
(1) Any Auto
(4) Owned Autos other than Private Passenger
(7) Autos Specified on Schedule
(2) All Owned Autos
(5) All Owned Autos which require No-Fault Coverage
(8) Hired Autos
(3) Owned Private Passenger Autos
(19) Mobile Equipment Subject to Auto Laws
(6) Owned Autos Subject to Compulsory U.M. Law
(9) Non-Owned Autos
Policywide Options
Limit
Deductible
Exposure
Premium
Hired Auto Coverage
If Any
Liability
$ 1,000,000
$
64.00
Non-Owned Auto Coverage
25
Liability
$ 1,000,000
$ 256.00 | Auto Coverage Options | Forms and Endorsements |
25% of covered loss up to a maximum of: | Coverage Details | Building Coverage Details |
Onsite visits will be charged on a daily basis (minimum 8 hours). | Onsite Visit Fees | Onsite Visits |
Constitutional - NAD, has been generally feeling well the last couple of weeks Eyes - no changes in vision, double vision, blurry vision, wears glasses ENT - No congestion, changes in hearing, does not wear hearing aids Skin/Breast - no rashes Cardiovascular - No SOB, chest pain, heart palpitations Pulmonary - hard to get a breath in but not short of breath, no cough Endocrine - No changes in appetite Gastro Intestinal - No n/v/d or constipation. Has not eaten because can't swallow solid
foods. | No Abnormal Symptoms | Neurological Exam Findings |
Tenant, at its sole cost and expense, shall maintain and make all necessary repairs to, and any necessary replacement of, any grease trap and drain in the Premises; and Tenant, at its sole cost and expense, shall at all times keep any grease trap and drain in the Premises clean and free from blockages and backups.
Tenant, at its sole cost and expense, shall install and maintain fire extinguishers and other fire protection devices as may be required from time to time, by any Requirements. | Tenant Installation Requirements | Fire Extinguishers and Fire Protection Devices |
All services provided below are subject to additional costs for work performed outside of regular working hours, as specified in section 2.3 of the MSA. All new work will be scoped with Customer before commencing. | Additional Costs Clause | Costs and Scoping |
No assignment of this Lease or acceptance of rent by Landlord from any assignee or other party shall discharge or release Tenant or any person, firm, or corporation which previously assumed Tenant's obligations hereunder, and Tenant and such persons, firms and corporations shall remain liable for the payment of rent due and to become due under this Lease and for the performance and observance of all of the terms, covenants and conditions of this Lease on the part of Tenant to be observed or performed for the balance of the term of this Lease as if no assignment has been effected. If this Lease is assigned, whether or not in violation of this Article, Landlord may collect rent from the assignee. If the demised Premises or any part thereof are sublet or occupied by anybody other than Tenant, Landlord, after any default by Tenant, may collect rent from the subtenant or occupant, and apply the net amount collected to the rent due hereunder. Such collection of rent by Landlord shall not be deemed or construed as a waiver of the provisions hereof, the acceptance of the assignee, subtenant or occupant as a tenant, or a release of Tenant from the further performance and observance by Tenant of the terms, covenants and conditions of this Lease.
(a) Whether or not the proposed assignment or sublease is finalized, Tenant shall pay Landlord the minimum sum of $750.00 to reimburse Landlord for the administrative costs of review and processing of Tenant’s proposed assignment or sublease, in each instance; and if, in connection therewith, Landlord incurs expenses in excess of said $750.00 amount, including but not limited to reasonable expenses for attorneys’ fees and disbursements, architectural fees, engineering or other professional fees, then Tenant shall pay Landlord the amount of such excess fees as additional rent within ten (10) days of Landlord’s submission to Tenant of bills for same. Upon submission to Landlord of Tenant’s request for consent to an assignment or sublease, Tenant shall deliver to Landlord a bank check payable to Landlord in the sum of $3,500.00 (“Application Costs Prepayment”) which shall be applied to Landlord’s legal fees and other costs incurred in connection with Landlord’s review and processing of Tenant’s request for
consent to such assignment or sublease. In the event that Landlord’s costs in this regard are less than such Application Costs Prepayment, Landlord will refund to Tenant the difference between Landlord’s costs incurred and the amount of the Application Costs Prepayment.
(b) In the event that this Lease is assigned or the Premises are sublet (except for any assignment or subletting which does not result in a change of beneficial ownership of this Lease, of in connection with an Assignment to an affiliate, successor or to a coporation intio which Tenant is merged or consolidated, or to an entity to which substantially all of the assets of Tenant are transferred), it shall be a condition of such assignment or subletting that Tenant shall deposit or arrange for the deposit with Landlord as security hereunder an additional amount equal to two (2) months fixed rent at the rate then in effect for the first assignment or subletting and an additional (2) months fixed rent at the rate then in effect for each and every subsequent assignment or subletting. | Assignment and Subletting | Assignment and Subletting |
Employee Benefits Liability(Claims Made Coverage) | Employee Benefits Liability | Employee Benefits Liability Coverage |
Tenant agrees that all signs, awnings, protective gates, security devices and other installations visible from the exterior of the Premises shall be subject to Landlord's prior written approval, shall be subject to the prior approval of the Landmarks Preservation Commission of the City of New York, if required, and shall not interfere with or block either of the adjacent stores, provided, however, that Landlord shall not unreasonably withhold consent for signs that Tenant desires to install. Tenant agrees that any permitted signs, awnings, protective gates, security devices, and other installations shall be installed at Tenant’s sole cost and expense professionally prepared and dignified and subject to Landlord's prior written approval, which shall not be unreasonably withheld, delayed or conditioned, and subject to such reasonable rules and restrictions as Landlord from time to time may impose. Tenant shall submit to Landlord drawings of the proposed signs and other installations, showing the size, color, illumination and general appearance thereof, together with a statement of the manner in which the same are to be affixed to the Premises. Tenant shall not commence the installation of the proposed signs and other installations unless and until Landlord shall have approved the same in writing. . Tenant shall not install any neon sign. The aforesaid signs shall be used solely for the purpose of identifying Tenant's business. No changes shall be made in the signs and other installations without first obtaining Landlord's prior written consent thereto, which consent shall not be unreasonably withheld, delayed or conditioned. Tenant shall, at its own cost and expense, obtain and exhibit to Landlord such permits or certificates of approval as Tenant may be required to obtain from any and all City, State and other authorities having jurisdiction covering the erection, installation, maintenance or use of said signs or other installations, and Tenant shall maintain the said signs and other installations together with any appurtenances thereto in good order and
condition and to the satisfaction of the Landlord and in accordance with any and all orders, regulations, requirements and rules of any public authorities having jurisdiction thereover. Landlord consents to Tenant’s Initial Signage described in annexed Exhibit D. | Signage Approval Required | Signage and Signage Requirements |
Carrier shall ensure that he/she and his/her/its drivers are properly trained and licensed, and are competent and capable of safely handling and transporting Shipper’s shipments of cargo. Carrier agrees that
drivers will be dispatched in accordance with the maximum available hours of service as provided in rules promulgated by the FMCSA while in the United States or as provided by any Canadian authority whose jurisdiction | Driver Training & Licensing | Driver Compliance |
concerning payment for transportation services; and, (ii) agrees to indemnify, defend, and hold Shipper, its customers, consignors, and consignees harmless from any claim or demand made by any subcontractor of Carrier or other party for payment for transportation services related to a shipment of cargo tendered under this Agreement. | Indemnification | Indemnification Clause |
8.2 Client’s Representation. Client represents that any materials provided to Company by Client for incorporation into the Deliverable will not (a) infringe on the intellectual property rights of any third party or any rights of publicity or privacy or (b) violate any law, statute, ordinance or regulation. | Intellectual Property Representation | No Violations |
one occurrence (See Utility Services – Direct Damage and Utility Services Time Element endorsements) | Utility Services Endorsements | Casualty Damage and Restoration |
[5] have venous access sufficient to allow for glucose infusion and blood sampling procedures as per protocol. | Venous Access Requirements | Venous Access Eligibility |
Landlord shall perform no work to prepare the Premises for the Tenant’s occupancy, except that Landlord shall deliver the Premises free of any hazardous materials and with no outstanding construction liens or violations.
Tenant shall maintain the submeter to register Tenant’s water consumption at Tenant’s sole cost and expense in good working order and repair, and Tenant shall pay for water consumed as shown on said water meter (“Base Water Charge”), plus Tenant’s Share of the cost of having the water meter read by a water meter reading company, within five (5) days of delivery by Landlord of a bill therefor. Tenant shall pay Tenant’s Share of sewer rent charges and assessments, if any, for the premises within five (5) days of delivery by Landlord of a bill therefor, which shall be additional rent.
If not already existing, Tenant shall install a backflow prevention device that is approved by the City Department of Environmental Protection (DEP) to prevent contaminated water or chemicals from flowing back into the public drinking supply, and in connection with such installation, Tenant shall comply with all provisions set forth elsewhere in this Lease. Tenant shall pay to Landlord as additional rent annually during the term of this Lease Tenant’s Share of Landlord’s costs and expenses for maintenance, inspection, certifications, testing and to comply with all other requirements of DEP with regard the backflow prevention device servicing its Premises. Such additional rent shall be paid within twenty (20) days after demand thereof by the Landlord and shall be collectible as additional rent. Bills for same submitted by Landlord shall be conclusive evidence of the amount of such costs and expenses and shall be used for the calculation of the amounts to be paid by the Tenant. | Water Meter Maintenance | Water and Sewer Charges |
BIRCH STREET, LLC
Landlord
By:
Trutone Lane LLC
Tenant
By:
ACKNOWLEDGMENTS | Landlord and Tenant Signatures | Landlord and Tenant Acknowledgments |
Deluxe Property Coverage Part Schedule – Specific Limits | Deluxe Property Coverage Limits | Property Coverage Details |
If the performance of Tenant’s Alterations shall interfere with the comfort and/or convenience of other tenants in the Building or shall cause damage to or otherwise interfere with the
occupancy of adjacent Buildings, Tenant shall upon Landlord's demand remedy or remove the condition or conditions complained of. Tenant further covenants and agrees to save Landlord harmless from and against any and all claims, losses, damages, costs, expenses including attorneys’ fees and disbursements, suits and demands whatsoever made or asserted against Landlord by reason of the foregoing. | Alteration Restrictions | Alterations and Restoration |
9. Indemnification. Client will defend, indemnify and hold Company harmless from any and all claims, losses, liabilities, damages, expenses and costs (including attorneys’ fees and court costs) arising from or relating to any claims regarding elements or materials provided by Client and incorporated into the Deliverable. Additionally, Client will defend, indemnify and hold Company harmless from any and all claims, losses, liabilities, damages, expenses and costs (including attorneys’ fees and court costs) arising from or relating to any claims regarding Client’s unauthorized use of any music, images, or other materials comprising the Deliverable. | Client Indemnification | Indemnification Clause |
(q) discotheque, ballroom, or dance hall. | Facility | License and Use Restrictions |
AVE, BLDG 1, HOUSTON, TX, 77082 | Address | Restaurant and Hotel Sales |
Note: The Premium shown above includes the premium charged for Equipment Breakdown coverage. The premium for Equipment Breakdown coverage is $8,359 If you elect not to purchase Equipment Breakdown coverage, please contact your Account Executive and a revised quote without Equipment Breakdown coverage will be sent to you. | Equipment Breakdown Coverage | Equipment Breakdown Coverage |
If Tenant is unable to obtain a permit for its Initial Alterations and/or a required permit or license to operate Tenant’s business due to any act or omission of Landlord's or due to a condition or violation arising prior to delivery of possession of the Demised Premises to Tenant (hereinafter collectively called "Pre-existing Conditions"), Landlord shall use best efforts to promptly correct such condition, and the time which expires until such condition is corrected and Tenant is notified of same shall be added on so that the Rent Commencement Date shall be deferred because of such Pre-existing Conditions. | Initial Alterations | Permitted Alterations |
53. Indemnification by Tenant
To the extent not otherwise provided herein, and excluding statutory and/or common law negligence of or willful action by Landlord, its agents, servants and/or employees, Tenant shall defend, indemnify and save harmless Landlord and its agents and employees against and from all liabilities, obligations damages, penalties, claims, costs, charges and expenses, including reasonable attorney’s fees, which may be imposed upon or incurred by or asserted against Landlord and/or its agents by reason of any of the following occurring during the term: (a) anything done in, on or about the Premises or any part thereof by or at the instance of Tenant, its agents, contractors, subcontractors, servants, employees, licensees, or invitees; (b) any negligence or otherwise wrongful act or omission on the part of Tenant or any of its agents, contractors, subcontractors, servants, employees, licensees, or invitees; (c) any accident, injury, or damage to any person or property occurring in, on or about the Premises or any part thereof; (d) any failure on the part of Tenant or any Licensee to perform or comply with any of the covenants, agreements, terms, provisions, conditions or limitations contained in this Agreement on its part to be performed or complied with. In case any action or proceeding is brought against Landlord by reason
of any such claim, Tenant upon written notice from Landlord shall, at Tenant’s sole cost and expense, oppose or defend such action or proceeding by counsel approved by Landlord in writing, which approval Landlord shall not unreasonably withhold. | Tenant Indemnification | Indemnification |
resume theophylline when patient can take oral meds | Resume Theophylline | Theophylline Use Restriction |
Utility Services:
LIMITS OF INSURANCE
Combined Direct Damage and Time Element - in any
one occurrence (See Utility Services – Direct Damage and Utility Services Time Element endorsements)
$100,000
Coverage is provided for the following: Water Supply
Communication Supply Power Supply
Coverage for Overhead Transmission Lines is: included. | Utility Services Insurance | Utilities Services Coverage |
Assignment. Without limiting anything contained elsewhere in this Agreement, Licensee shall not assign this Agreement or any rights herein without the prior written consent of Licensor, which consent may be arbitrarily withheld. Any purported assignment without Licensor's consent shall be deemed to be null and void. | Assignment Restriction | Assignment Restriction |
o Diagnosed 2001 as tonic-clonic seizure with postictal state lasting approx 45 min. Suspected posttraumatic etiology, although cocaine abuse could have contributed.
o Last seizure per wife approx 3 years ago. Currently not on antiepileptic medications.
o Previous EEG done at initial presentation of seizure event demonstrated some right frontotemporal slowing and spiked discharges. | Medical History | Diagnosis |
60. Notices
All notices, bills, statements, demands, requests or other communication given, required or permitted to be given hereunder shall be sent by registered or certified mail, return receipt requested, or by nationally recognized overnight courier) addressed as follows or to such other address as either Landlord or Tenant may designate as its new address for such purpose by notice given to the others in accordance with the provisions of this Article 60. Such notice shall be deemed given when received. | Notice Requirements | Notices |
This Mutual Non-Disclosure Agreement (this “Agreement”) is entered into and made effective as of April 4, 2018 between Docugami Inc., a Delaware corporation, whose address is 150 Lake Street South, Suite 221, Kirkland, Washington 98033, and Caleb Divine, an individual, whose address is 1201 Rt 300, Newburgh NY 12550. | Mutual NDA Agreement | Agreement Preamble |
Personal Property at each premises | Personal Property | Personal Property |
The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot's improper flare during landing. | Cause of Accident | Probable Cause |
Protocol Amendment I8B-MC-ITRV(b) Summary: A Study to Evaluate the Pharmacokinetics and Glucodynamics of LY900014 compared to Humalog® in Patients with T1DM .....................................64 | Protocol Amendment Summary | Study Amendment |
XTEND ENDORSEMENT FOR SERVICE INDUSTRIES | Service Industries Endorsement | XTEND Endorsement |
Tenant, at its sole cost and expense, shall install and maintain fire extinguishers and other fire protection devices as may be required from time to time, by any Requirements. | Fire Protection Devices | Fire Protection Devices |
Company will maintain during the entire Term of this Agreement, at its own expense, the types of insurance coverage specified below, on standard policy forms and with insurance companies with at least an A.M. Best Rating of A-VII authorized to do business in the jurisdictions where the Company services are to be performed. | Insurance Coverage Requirements | Insurance Coverage |
b. CRD shall have no obligation to pay for any Product or to reimburse CP for any losses incurred in connection with the failure of any Customer to pay CP any amount due. | No Payment Obligation | No Payment Obligation |
FIXED RENT:
TERM
YEAR
PERIOD
MONTHLY
RENT
ANNUAL
RENT
First
3/15/21 To 2/28/23
$26,000.00
$312,000.00
Second
3/01/23 To 2/28/24
$26,000.00
$312,000.00
Third
3/01/24 To 2/28/25
$26,000.00
$312,000.00
Fourth
3/01/25 To 2/28/26
$26,780.00
$321,360.00
Fifth
3/01/26 To 2/28/27
$27,583.40
$331,000.80
Sixth
3/01/27 To 2/28/28
$28,410.90
$340,930.80
Seventh
3/01/28 To 2/28/29
$29,263.23
$351,158.76
Eighth
3/01/29 To 2/28/30
$30,141.13
$361,693.56
Ninth
3/01/30 To 2/28/31
$31,045.36
$372,544.32
Tenth
3/01/31 To 3/31/32
$31,976.72
$383,720.64
The fixed rent shall be payable in advance on the first day of each calendar month commencing five months following the Commencement Date (the “Rent Commencement Date’) . Provided Tenant is not in default under any term of this Lease Tenant shall receive a rent credit for (i)) one-half of the monthly fixed rent due ($13,000.00) for the sixth month following the Commencement Date; (ii) one- half of the monthly fixed rent due ($13,000.00) for the seventh month following the Commencement Date;
(iii) one-half of the monthly fixed rent due ($13,000.00) for the eighteenth month following the Commencement Date; and (iv) one-half of the monthly fixed rent due ($13,000.00) for the nineteenth month following the Commencement Date.
At execution of this Lease, Tenant shall pay to Landlord by separate bank checks (i) the amount of $26,000.00 toward fixed rent for for the seventh month following the Commencement Date and
(ii) the amount of $78,000.00 representing the security deposit.
Tenant also covenants to pay, from time to time as provided in this Lease, as additional rent: all other amounts and obligations which Tenant assumes or agrees to pay under this Lease; a “Late Charge” equal to five percent (5%) of the overdue payment of any item of fixed or additional rent not paid within ten (10) days after the date when due (or, if a demand therefor is required by the provisions of this Lease, within ten (10) days after the date of such demand), which Late Charge shall be payable as additional rent. In the event of any failure on the part of Tenant to pay any additional rent, Landlord shall have all the rights, powers and remedies provided for in this Lease, at law, in equity or otherwise, in the case of nonpayment of fixed rent. Nothing herein shall be construed to extend the due dates of Tenant's payments under this Lease, or to waive any rights or remedies of Landlord in the event of Tenant's late payment. Tenant's obligations to pay fixed rent and additional rent shall survive the expiration of the Lease term or earlier termination of this Lease.
The provisions of this Article are in addition to all other rights or remedies available to Landlord for nonpayment of fixed rent or additional rent under this Lease and at law and in equity. Tenant further agrees that the Late Charge imposed is fair and reasonable, complies with all laws, regulations and statutes, and constitutes an agreement between Landlord and Tenant as to the estimated compensation for costs and administrative expenses incurred by Landlord due to the late payment of rent to Landlord by Tenant. Tenant further agrees that the Late Charge assessed pursuant to this Lease is not interest and the Late Charge assessed does not constitute a lender or borrower/creditor relationship between Landlord and Tenant or a penalty of any kind. It is understood that said late charge is directly related to Landlord’s actual costs and expenses incurred as a result of late payment.
All fixed rent and additional rent (collectively hereinafter referred to as "rent") shall be paid in such coin or currency (or, subject to collection, by good check payable in such coin or currency) of the United States of America as at the time shall be legal tender for the payment of public and private debts, at the office of Landlord as set forth above, or at such place and to such person as Landlord from time to time may designate.
All rent shall be paid to Landlord without notice, demand, counterclaim, setoff, deduction or defense, and nothing shall suspend, defer, diminish, abate, or reduce any rent, except as otherwise specifically provided in this Lease or by law.
Tenant shall make all rental payments in full. Payment or receipt of a rental payment of less than the amount stated in this Lease shall be deemed to be nothing more than partial payment on account. Under no circumstances shall Landlord’s acceptance of a partial payment constitute accord and satisfaction. Nor will Landlord’s acceptance of a partial payment forfeit Landlord’s right to collect the balance due on the account, together with applicable late charges and interest despite any endorsement, stipulation, or other statement on any check.
Landlord may accept any partial payment check with any conditional endorsement without prejudice to its right to recover the balance remaining due, or to pursue any other remedy available under this Lease, law or equity.
Landlord in its sole discretion may allocate without prejudice any payment in whole or in part to any due item of fixed rent, additional rent and/or any other charges or to any combination thereof.
If Landlord commences any action or proceeding against Tenant, or if Landlord is required to defend any action or proceeding commenced by Tenant, in connection with this lease or the Premises, and Landlord shall be the prevailing party in any such action for proceeding, Landlord shall be entitled to recover from Tenant in such action or proceeding, or a subsequently commenced action or proceeding, Landlord's reasonable attorneys' fees, costs and disbursements and all applicable interest thereon at the statutory rate incurred in connection with such action or proceeding and any appeals, including but not limited to fees on fees incurred to collect said monies.
Landlord’s failure during the Lease term to prepare and deliver any of the statements, notices, or bills for rent and/or additional rent or Landlord’s failure to make a demand, shall not in any way cause Landlord to forfeit or surrender its rights to collect any of the items of rent and/or additional rent that may have become due during the term of this Lease. Tenant’s liability for all such amounts due under this Lease shall survive the expiration of the Term. Nevertheless, any sums due under the Lease must be claimed within two years of when due or within one year from expiration of the Lease.
40A. Term of Lease
The term of this Lease shall commence on October 15, 2018 ( the Commencement Date”) and shall end, unless sooner terminated as hereinafter provided, on the la s t day of th e ca l e n d a r mo n t h in w h ic h t h e d a y f o llo w in g t h e t e n ( 1 0 ) year anniversary of the Re n t Commencement Date (as defined in Article 40 of this Lease) occurs (the "Expiration Date") (from the Commencement Date to the Expiration Date being the "Initial Term", as may be extended pursuant to and in accordance with Section 72 hereof.
41. Escalations
Tenant shall pay, during the term of this Lease, the additional rent provided for in this Article 41. As used herein, the following terms shall have the meanings set forth below:
“Taxes” shall mean the total of all real estate taxes and assessments and special assessments imposed, payable and paid upon the Premises described as the land and building in which the Premises are located including, without limitation, vault taxes, rents or charges, imposed by any Governmental Authority, of which the demised Premises forms a part. If at any time during the term of this Lease the methods of taxation prevailing at the commencement of the term hereof shall be altered so that in lieu of or as a substitute for the whole or any part of the taxes, assessments, levies, impositions of charges now levied, assessed or imposed on the real estate and the improvements thereon, there shall be levied, assessed or imposed (i) a tax, assessment, levy imposition or charge wholly or partially as capital levy or otherwise on the rents received therefrom, or (ii) a tax assessment levy upon the Building, Land Improvements or the Premises and imposed upon Landlord, or (iii) a license fee measured by the rents payable, or the part thereof so measured or based shall be deemed to be included within the term "Taxes" for the purposes hereof.
"Escalation Year" shall mean each twelve month period or portion thereof, ending on June 30, occurring within the term of this Lease.
"Base Year" shall mean the twelve month period ending on June 30, 2022.
"Base Year Taxes" shall mean the Taxes for the Base Year.
The "building" shall mean the land and the building of which the demised Premises forms a part. "Tenant's Share" shall mean 35%.
Tenant shall pay to Landlord, as additional rent, an amount equal to Tenant's Share of the amount by which Taxes for any Escalation Year during the term of this Lease exceed the Base Year Taxes.
Landlord shall submit to Tenant a statement setting forth the computation of the amount of such excess Taxes and Tenant's Share of each thereof including copies of applicable tax bills. Tenant shall pay Tenant's Share of such excess amount of Taxes within ten days after the rendition of such statement which shall separately calculate Tenant’s Share, however, the payment of Tenant's Share shall not be due earlier than 10 days before the corresponding Taxes are due to the taxing authority.
In no event shall the annual fixed rent under this Lease be reduced by virtue of this Article
41. The computations under this Article 41 are intended to constitute a formula for an agreed rental escalation and do not necessarily constitute an actual reimbursement to Landlord for costs or expenses paid by Landlord with respect to the building.
| Rent Schedule | Fixed Rent |
UA: glucose = neg, bile = neg, ketone = trace, Hgb = neg, alb = trace, urobil = 1.0, nitrite = neg, leukocyte = neg | Urinalysis Results | Urinalysis Results |
Gross Premium:
$67,797 | Gross Premium Amount | Alcoholic Beverage Sales |
(a) the sale, rental or use of amusement devices, pinball machines, electronic computer, card games, games of chance of any kind, or video type amusement machines, games or devices (such as Pacman);
(b) pornographic movie theater or live "sex show" theater;
(c) bowling alley;
(d) billiard parlor or pool hall,;
(e) funeral parlor;
(f) massage parlor;
(g) gasoline station;
(h) sale or rental of pornographic literature (such as an "Adult Book Store");
(i) the sale or rental of video tapes of X-Rated, R-Rated, PG-Rated, Not-rated or any kind of movies or "pornographic" movies;
(j) flea market, bingo or other game hall or meeting room;
(k) drug abuse treatment center;
(l) methadone maintenance clinic or center;
(m) the sale of paraphernalia used in connection with illicit drugs;
(n) any games of chance or gambling, in any form (including, but not limited to horse racing, such as an OTB parlor, but excluding the sale of lottery tickets that are sponsored by federal, state, county or local authorities);
(o) the sale of prescription drugs, cosmetics, health and beauty aid products and pharmaceutical products;
(p) intentionally omitted;
(q) discotheque, ballroom, or dance hall. | Prohibited Use | Permitted Use |
12.2 Intellectual Property.
12.2.1 Preexisting Intellectual Property. Except for rights expressly granted under this agreement, each party will retain exclusive interest in and ownership of its Intellectual Property developed before this agreement or developed outside the scope of this agreement.
12.2.2 Independently Developed Intellectual Property. Any Intellectual Property developed solely by a party under this agreement without the participation of the other party is and will remain the sole and exclusive property of the developing party.
12.3 Assignment Neither party may assign this Agreement without the prior written consent of the other party and any attempt to do so will be void. Any notice or consent under this Agreement will be in writing to the address specified below. If any provision of this Agreement is adjudged by any court of competent jurisdiction to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary so that this Agreement will otherwise remain in full force and effect. Any waivers or amendments shall be effective only if made in writing signed by a representative of the respective parties. Both parties agree that this Agreement is the complete and exclusive statement of the mutual understanding of the parties, and supersedes and cancels all previous written and oral agreements and communications relating to the subject matter of this Agreement. Both parties agree that the Agreement is signed by a duly, authorized company representative authorized to bind the company to its terms and services and no consent from any third party is required.
12.4 Force Majeure. Force Majeure. Neither party shall be liable for any failure or delay in performance under this Agreement for causes beyond that party’s reasonable control and occurring without that party’s fault or negligence, including, but not limited to, acts of God, acts of government, flood, fire, civil unrest, acts of terror, strikes or other labor problems (other than those involving Client or Client employees, respectively). Dates by which performance obligations are scheduled to be met will be extended for a period of time equal to the time lost due to any delay so caused.
13. Choice of Law. This Agreement will be deemed to have been made in, and shall be construed pursuant to the laws of the State of Washington and the United States without regard to conflicts of laws provisions thereof. Any suit or proceeding arising out of or relating to this Agreement shall be commenced in a federal or state court in Kirkland, Washington, and each party irrevocably submits to the jurisdiction and venue of such courts.
14. Remedies. Company reserves all remedies available at law or equity for any disputes that arise under this Agreement. In the event of a suit or proceeding under this Agreement, Client agrees to pay all attorneys’ fees if the federal or state court renders judgment substantially in Company’s favor.
B. INITIAL STATEMENT OF WORK (SOW) The purpose of this SOW is to describe the Software and Services that Company will initially provide to Daltech, Inc. the “Client”) under the terms and conditions of the Services Agreement entered into between the parties on June 15, 2021 (the “Agreement”). Additional terms and conditions may be set forth in this SOW, and additional SOWs that may be subsequently signed. | Intellectual Property Rights, Assignment Restriction | Assignment |
DELUXE BI (AND EE) COVERAGE FORM | Coverage Form | Building Coverage Details |
Dispo: Full code. Will consult social work to assist with Medicaid. Patient will return home with wife when medically cleared. | Discharge Plan | Disposition |
This Agreement will remain in effect for a period of seven (7) years from the date of last disclosure of Confidential Information by either party, at which time it will terminate. | Agreement Term | Termination Clause |
Exhibits. All exhibits, riders, and addenda attached to this Lease shall, by this reference, be incorporated into this Lease. The following exhibits are attached to this Lease:
EXHIBIT "A"
– Legal Description of the Project
EXHIBIT "B"
– Location of Premises
EXHIBIT "C"
– Guaranty
EXHIBIT "D"
– Rules and Regulations
EXHIBIT "E"
– Tenant Improvements
EXHIBIT "F"
– Restricted Uses
EXHIBIT “G”
– Letter of Credit
EXHIBIT “H”
– Form of SNDA | Exhibits Attached | Exhibits |
If Tenant installs and/or utilizes cooking equipment on the Premises: | Cooking Equipment Use | Cooking Equipment |
68. Air Conditioning Maintenance and Repair
Landlord shall have no obligation to furnish to Tenant or the Premises air conditioning. Any air conditioning unit and equipment located in or servicing the Premises (the "Air Conditioning System") on the date the term of this Lease shall commence may be utilized by Tenant provided that Landlord shall have no obligation with respect thereto and that Tenant shall accept the same in its "AS IS" condition. Tenant shall, at its sole cost and expense (a) maintain and promptly make all repairs and replacements, structural or otherwise, ordinary and extraordinary, to all components of the Air Conditioning System, (b) maintain throughout the term of the lease a full service contract covering the Air Conditioning System with Henick-Lane Service Corp. or any other company of reasonably equivalent quality and reputation, (c) pay all permit fees and other costs associated with any Air Conditioning System, and (d) deliver to Landlord a copy of said full service contract within five business days of demand by Landlord. Tenant shall not be released or excused from the performance of any of its obligations under this Lease for any failure or for interruption or curtailment of any Air Conditioning System, for any reason whatsoever, and no such failure, interruption, or curtailment shall constitute a constructive or partial eviction.
69. Compliance with Anti-Terrorism, Embargo, Sanctions and Anti-Money Laundering Laws.
Tenant represents that neither Tenant, nor the principals, officers, partners, and/or members of Tenant: (i) is currently identified on the list maintained by the U.S. Department of the Treasury, Office of Foreign Assets Control ("OFAC"), generally known as the OFAC List" (formerly known as the Specially Designated Nationals and Blocked Persons List); (ii) is currently identified on the lists maintained by the U.S. Department of Commerce (the "DOC List") and/or the U.S. Bureau of Industry and Security (the "BIS List"); (iii) acts for or on behalf of any person or persons listed on the OFAC List, the DOC List, the BIS List, and/or any other known list of denied persons, excluded persons, and excluded entities maintained by the federal agencies of the United States; and (iv) is a person or persons, or acts for or on behalf of any person or persons, with whom a citizen or business of the United States is prohibited to engage in transactions by any trade embargo, economic sanction, or other prohibition of United States law, regulation, or Executive Order of the President of the United States of America. | Air Conditioning Maintenance | Air Conditioning Maintenance and Repair |
Notes to physician
:
In case of inhalation of decomposition products in a fire, symptoms
may be delayed. The exposed person may need to be kept under medical surveillance for 48 hours.
Specific treatments
:
No specific treatment.
Protection of first-aiders
:
No action shall be taken involving any personal risk or without
suitable training. | Notes to Physician | Treatment of Decomposition Products |
SHOPPING CENTERS - MAINTAINED BY THE LESSEE (LESSOR'S RISK ONLY) | Shopping Center Maintenance | Shipping and Maintained by Lessee |
All work will be executed during regular working hours Monday-Friday 0800-1900. For work outside of these hours on weekdays, Company will charge one hundred percent (100%) of the regular hourly rate and two hundred percent (200%) for Saturdays, Sundays and public holidays applicable to Company. | Working Hours & Rates | Time and Charges |
Meteorological Information and Flight Plan
Conditions at Accident Site:
Instrument Conditions
Condition of Light:
Observation Facility, Elevation:
Distance from Accident Site:
Observation Time:
Direction from Accident Site:
Lowest Cloud Condition:
Visibility
Lowest Ceiling:
Visibility (RVR):
Wind Speed/Gusts:
/
Turbulence Type Forecast/Actual:
/
Wind Direction:
Turbulence Severity Forecast/Actual:
/
Altimeter Setting:
Temperature/Dew Point:
Precipitation and Obscuration:
Departure Point:
Type of Flight Plan Filed:
Unknown
Destination:
Jaleg, UN
Type of Clearance:
Departure Time:
Type of Airspace: | Flight Plan Details | Meteorological Information |
++Swollen tongue:
• Give patient corticosteroid to decrease inflammation and to protect against relapse after initial improvement. 4 days of Dexamethasone 10 mg IV tid.
• Give patient antihistamine to block inflammation as well. 4 days of Diphenhydramine 25 mg bid.
• ENT consult to rule out abscess or foreign object
• Check C1 and C4 levels that would be decreased if the patient had C1 inhibitory complement deficiency
• TSH level to check for hypo/hyper thyroid
• Hold all oral home meds and keep patient NPO until airway swelling is reduced and patient can swallow easily | Treatment Plan | MRI Results |
Fungus, Wet Rot or Dry Rot – Amended Period of Restoration | Fungal Wet or Dry Rot Restoration | Restoration Period |
Green Building Alternatives – Increased Cost | Green Building Costs | Green Building Alternatives |
(m) the sale of paraphernalia used in connection with illicit drugs; | Prohibited Use | Illegal Products |
Landlord shall perform no work to prepare the Premises for the Tenant’s occupancy, except that Landlord shall deliver the Premises free of any hazardous materials and with no outstanding construction liens or violations. | No Landlord Work | No Landlord Work |
6.12 Administrative Fee. Tenant shall pay to Landlord, on demand, an administrative fee of $5,000, plus all reasonable attorneys' fees and actual costs associated with Landlord's consideration of Tenant's transfer request and the review and preparation of all documents associated therewith. | Administrative Fee | Administrative Fee |
In consideration of the foregoing, the parties agree as follows: | Agreement Consideration | Agreement Terms |
Use a properly fitted, particulate filter respirator complying with an | Respirator Requirements | Exclusive Use and No Solicitation |
This Services Agreement (the “Agreement”) sets forth terms under which MagicSoft, Inc. a Washington Corporation (“Company”) located at 600 4th Ave, Seattle, WA 98104 shall provide services to Daltech, Inc., a Washington Corporation (the “Client”) located at 701 1st St, Kirkland, WA 98033. This Agreement is effective as of February 15, 2021 (“Effective Date”).
A. STANDARD SOFTWARE AND SERVICES AGREEMENT
1. Deliverables. Company shall provide Client with software, technical support, product management, development, and testing services (“Services”) to the Client as described on one or more Statements of Work signed by Company and Client that reference this Agreement (“SOW” or “Statement of Work”). Company shall perform Services in a prompt manner and have the final product or service (“Deliverable”) ready for Client no later than the due date specified in the applicable SOW (“Completion Date”). This due date is subject to change in accordance with the Change Order process defined in the applicable SOW. Client shall assist Company by promptly providing all information requests known or available and relevant to the Services in a timely manner.
2. Onsite Services.
2.1 Onsite visits will be charged on a daily basis (minimum 8 hours).
2.2 Time and expenses will be charged based on actuals unless otherwise described in an Order Form or accompanying SOW.
2.3 All work will be executed during regular working hours Monday-Friday 0800-1900. For work outside of these hours on weekdays, Company will charge one hundred percent (100%) of the regular hourly rate and two hundred percent (200%) for Saturdays, Sundays and public holidays applicable to Company.
2.4 If scheduled onsite visits are cancelled less than ten (10) working days in advance of the scheduled date, Company is entitled to charge fifty percent (50%) of the expected revenue associated with this onsite activity as compensation.
3. Deposit. An initial payment (the “Deposit”) of One Hundred Thousand Dollars ($100,000) is due to Company at signing.
4. Dates of Performance. Company will begin performing services upon receipt of signed Agreement and Deposit. Unless terminated as provided in this Agreement, Company will complete Services by the Completion Date. Deliverable shall be furnished to Client within 72 hours of final payment for the Services.
5. Change in Services. If Client desires changes to the SOW, Client shall submit to Company a written request in accordance with the change order process defined in the applicable SOW. The parties may execute additional Statements of Work describing Services, which will become part of this Agreement upon execution by Company and the Client. If additional SOW are executed, then Client shall pay Company for all services performed prior to the additional SOW before Company begins work on the new SOW.
6. Termination. This agreement shall continue in force and effect until May 31, 2025 and shall be automatically renewed for successive one-year terms annually thereafter unless notice of non-renewal is given by the Company or the Client before the end of the term. Company shall have the right to modify, reject, or terminate any SOW and any related work in process with five days written notice to Client. In the event Company terminates the SOW prior to completion of Services, the Client shall pay Company the fees due under the SOW with respect to Services completed as of the date of termination. Payment for completed work will be deducted from the deposit. Company will retain the non-refundable 50% of the Deposit and return any unearned portion exceeding 50% of the Deposit. Any amount due for services performed by Company above the deposit will be billed to Client and Client shall promptly pay.
7. Payment. In exchange for Company’s Services under this Agreement, the Client shall pay Company the contract price and deposit set forth above. Company will submit a final invoice to Client for all services rendered by the Services Completion Date and Client shall promptly pay. Client is restricted from using any form of the Deliverable until final payment is received. Client shall pay travel and other expenses incurred by Company in performing the Services. In the event of a good faith dispute with regard to an item appearing on an invoice, Company shall have the right to withhold the Deliverable while the parties attempt to resolve the disputes.
8. Representations and Warranties.
8.1 Company’s Representation. Company represents that any materials used in the Deliverable will not knowingly (a) infringe on the intellectual property rights of any third party or any rights of publicity or privacy or (b) violate any law, statute, ordinance or regulation.
8.2 Client’s Representation. Client represents that any materials provided to Company by Client for incorporation into the Deliverable will not (a) infringe on the intellectual property rights of any third party or any rights of publicity or privacy or (b) violate any law, statute, ordinance or regulation.
8.3 Warranty Disclaimer. EXCEPT FOR THE WARRANTIES SET FORTH IN THIS AGREEMENT AND ANY SOW, EACH PARTY EXPRESSLY DISCLAIMS ANY AND ALL OTHER WARRANTIES OF ANY KIND OR NATURE, WHETHER EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
9. Indemnification. Client will defend, indemnify and hold Company harmless from any and all claims, losses, liabilities, damages, expenses and costs (including attorneys’ fees and court costs) arising from or relating to any claims regarding elements or materials provided by Client and incorporated into the Deliverable. Additionally, Client will defend, indemnify and hold Company harmless from any and all claims, losses, liabilities, damages, expenses and costs (including attorneys’ fees and court costs) arising from or relating to any claims regarding Client’s unauthorized use of any music, images, or other materials comprising the Deliverable.
10. Limitation of Liability. COMPANY WILL NOT BE LIABLE FOR ANY LOSS OF USE, INTERRUPTION OF BUSINESS, LOST PROFITS, OR ANY INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES OF ANY KIND REGARDLESS OF THE FORM OF ACTION WHETHER IN CONTRACT, TORT (INCLUDING NEGLIGENCE), STRICT PRODUCT LIABILITY, OR OTHERWISE, EVEN IF IT HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
11. Compliance with Laws. Each party shall perform all of its obligations under this Agreement in compliance at all times with all foreign, federal, state and local statutes, orders and regulations, including those relating to privacy and data protection.
12. General Provisions.
12.1 Insurance Company will maintain during the entire Term of this Agreement, at its own expense, the types of insurance coverage specified below, on standard policy forms and with insurance companies with at least an A.M. Best Rating of A-VII authorized to do business in the jurisdictions where the Company services are to be performed.
(a) Workers’ Compensation insurance prescribed by applicable local law and Employers Liability insurance with limits not less than $1,000,000 per accident/per employee. This policy shall include a waiver of subrogation against Client.
(b) Business Automobile Liability covering all vehicles that Company owns, hires or leases with a limit of no less than $1,000,000 (combined single limit for bodily injury and property damage) for each accident.
(c) Commercial General Liability insurance including Contractual Liability Coverage, with coverage for products liability, completed operations, property damage and bodily injury, including death, with an aggregate limit of no less than $2,000,000. This policy shall name Client as an additional insured with respect to the provision of services provided under this Agreement. This policy shall include a waiver of subrogation against Client.
(d) Technology Professional Liability Errors & Omissions policy (which includes Cyber Risk coverage and Computer Security and Privacy Liability coverage) with a limit of no less than $5,000,000 per occurrence and in the aggregate.
(e) Crime policy with a limit of no less than $5,000,000 per occurrence and in the aggregate.
(f) Excess Liability/Umbrella coverage with a limit of no less than $9,000,000 per occurrence and in the aggregate (such limit may be achieved through increase of limits in underlying policies to reach the level of coverage shown here). This policy shall name Client as an additional insured with respect to the provision of services provided under this Agreement. This policy shall include a waiver of subrogation against Client.
Upon Client's request, Company agrees to deliver to Client a certificate(s) of insurance evidencing the coverage specified in this Section. Such certificate(s) will contain a thirty (30) day prior notice of cancellation provision. Company will be solely responsible for any deductible or self-insurance retentions. Such insurance coverage will be primary and any other valid insurance existing will be in excess of such primary insurance policies. The required insurance coverage and limits of liability set forth above shall not be construed as a limitation or waiver of any potential liability of satisfaction of any indemnification/hold harmless obligation of Company.
12.2 Intellectual Property.
12.2.1 Preexisting Intellectual Property. Except for rights expressly granted under this agreement, each party will retain exclusive interest in and ownership of its Intellectual Property developed before this agreement or developed outside the scope of this agreement.
12.2.2 Independently Developed Intellectual Property. Any Intellectual Property developed solely by a party under this agreement without the participation of the other party is and will remain the sole and exclusive property of the developing party.
12.3 | Services Agreement | Software & Services Agreement |
Chief Complaint:
"swelling of tongue and difficulty breathing and swallowing"
History of Present Illness:
77 y o woman in NAD with a h/o CAD, DM2, asthma and HTN on altace for 8 years awoke from sleep around 2:30 am this morning of a sore throat and swelling of tongue. She came immediately to the ED b/c she was having difficulty swallowing and some trouble breathing due to obstruction caused by the swelling. She has never had a similar reaction ever before and she did not have any associated SOB, chest pain, itching, or nausea. She has not noticed any rashes, and has been afebrile. She says that she feels like it is swollen down in her esophagus as well. In the ED she was given 25mg benadryl IV, 125 mg solumedrol IV and pepcid 20 mg IV. This has helped the swelling some but her throat still hurts and it hurts to swallow. Nothing else was able to relieve the pain and nothing make it worse though she has not tried to drink any fluids because of trouble swallowing. She denies any recent travel, recent exposure to unusual plants or animals or other allergens. She has not started any new medications, has not used any new lotions or perfumes and has not eaten any unusual foods. Patient has not taken any of her oral medications today.
Surgical History:
s/p vaginal wall operation for prolapse 2006 s/p Cardiac stent in 1999 s/p hystarectomy in 1970s s/p kidney stone retrieval 1960s
Medical History:
+CAD w/ Left heart cath in 2005 showing 40% LAD, 50% small D2, 40% RCA and 30% large OM; 2006 TTE showing LVEF 60-65% with diastolic dysfunction, LVH, mild LA dilation +Hyperlipidemia +HTN
+DM 2, last A1c 6.7 in 9/2005 +Asthma/COPD +GERD +h/o iron deficiency anemia
Social History:
Patient lives in with daughter (919) _ . Patient does all ADLs and IADLs with no/little assistance. She does own finances and drives. Patient has 4 daughters that all live in the area. Patient does not use tobacco, alcohol, illicit drugs.
Family History:
Patient's Dad died of liver cirrhosis at age 57, mom died of heart attack at age 60. She has 6 siblings who most died of cardiac disease. There is no family history of cancer.
Allergies:
Sulfa drugs - rash Cipro - rash Benadryl – causes mild dystonic reaction
Medications:
Theophyline (Uniphyl) 600 mg qhs – bronchodilator by increasing cAMP used for
treating asthma Diltiazem 300 mg qhs – Ca channel blocker used to control hypertension Simvistatin (Zocor) 20 mg qhs- HMGCo Reductase inhibitor for hypercholesterolemia Ramipril (Altace) 10 mg BID – ACEI for hypertension and diabetes for renal protective
effect
Glipizide 5 mg BID (diabetes) – sulfonylurea for treatment of diabetes Omecprazole (Prilosec) 20 mg daily (reflux) – PPI for treatment of ulcers Gabapentin (Neurontin) 100 mg qhs – modulates release of neurotransmitters to treat
diabetic neuropathy Metformin 500 mg qam – biguanide used to treat diabetes Aspirin 81 mg qam - prophylaxis for MI and TIA Servant 1puff bid -
Fluticasone (Flovent) 2 puff bid - corticosteroid to treat airways in asthma/copd xoperex 1.25mg and Ipratropium 2.5 ml nebulized qam - anticholinergic to treat airways
in COPD
Review of Systems:
Constitutional - NAD, has been generally feeling well the last couple of weeks Eyes - no changes in vision, double vision, blurry vision, wears glasses ENT - No congestion, changes in hearing, does not wear hearing aids Skin/Breast - no rashes Cardiovascular - No SOB, chest pain, heart palpitations Pulmonary - hard to get a breath in but not short of breath, no cough Endocrine - No changes in appetite Gastro Intestinal - No n/v/d or constipation. Has not eaten because can't swallow solid
foods.
Genito Urinary - No increased frequency or pain on urination. Some urge incontinence
with history of prolapse. Musculo Skeletal - no changes in strengths, no joint tenderness or swelling Neurologic - No changes in memory Psychology - No changes in mood Heme/Lymph - Denies easy bruising
Physical Examination:
Vitals: Temp 35.9 Pulse 76 O2 98% RA RR 20 BP 159/111
General - NAD, sitting up in bed, well groomed and in nightgown Eyes - PERRLA, EOM intact ENT - Large swollen tounge and cheek on left side, tounge was large and obscured the view of the posterior oropharynx Neck - No noticeable or palpable swelling, redness or rash around throat or on face Lymph Nodes - No lymphadenopathy Cardiovascular - RRR no m/r/g, no JVD, no carotid bruits Lungs - Clear to auscltation, no use of acessory muscles, no crackles or wheezes. Skin - No rashes, skin warm and dry, no erythematous areas Breast - Psychiatry -
Abdomen - Normal bowel sounds, abdomen soft and nontender Genito Urinary – Genital exam not performed since complaints not related. Rectal – Rectal exam not performed since no symptoms indicated blood loss. Extremeties - No edema, cyanosis or clubbing Musculo Skeletal - 5/5 strength, normal range of motion, no swollen or erythematous
joints.
Neurological – Alert and oriented x 3, CN 2-12 grossly intact.
Pertinent Diagnostic Tests:
Na 140 K 4.5 Cl 109 Co2 23 BUN 29 Cr 1.0 Ca 9.9 Mg 1.4 Phos 3.6
PTT 26.7 WBC 9.9 Hgb 10.0 Hct 30.3 Plt 373
EKG - no signs of ischemia
Assessment and Plan:
77 yo woman presents with significant angioedema in left side of tongue and inner cheek. Possible causes of angioedema include allergic anaphylaxis reaction, drug induced, allergic contact dermatitis, viral infection, drug induced, or a C1 inhibitor deficiency disorder acquired or hereditary. Laryngeal edema can also be caused by tonsillitis, peritonsilar abscess or pharyngeal foreign body.
It is unlikely that the patient has edema caused by abscess or tonsillitis since she does not have any associated fever or other signs of infection and the sudden onset of her swelling also argues against this. It is not likely a foreign body since ENT did not find anything when they scoped her.
It is unlikely that it is caused by a mast cell mediated etiologigy that increases vascular permeability through mast cell degranulation and release of inflammatory mediators include allergic angioedema, autoimmune mast cell release and direct mast cell release caused by medications such as opiates and radiocontrast media. It is not likely this type of reaction because these etiologies are associated with urticaria and pruritis, which the patient did not have. Also the patient did not have any exposure to a new pet, food, lotion or any other allergen or medication that could cause an allergic type reaction. The patient also does not have any history of autoimmune disease or any reaction similar to this in the past
It is more likely that the etiology is kinin-related where angioedema results from generation of bradykinin and complement-derived mediators that increase vascular permeability since there is no urticaria or pruritis. The most likely cause is the Altace (ACEI) that the patient has been taking caused an increase in bradykinin since it decreases angiotensin 2 which degrades bradykinin. Bradykinin can then interact with vascular receptors increasing vasodilation, vascular permeability, increased cGMP and release of nitric oxide. This reaction occurs in .1-7% of patients treated with an ACEI and it typically involves the mouth, lips, tounge, larynx, pharynx and sublottic tissues. Half of these cases usually occur within a week of starting the ACEI but can occur years later. This is a class specific reaction not a drug specific and ARBs can cause the same reaction even though these drugs don’t effect the kinin metabolism. 50% of patients with angioedema due to an ARB also had an ACEI induced angioedema (Cicardi, M, Zingale, LC, Bergamschini L, Agostoni, A. Angioedema associated with agniotensin-converting enzyme inhibitor use: outcome after switching to a different treatment. Arch Intern Med 2004; 164:910). Deficiency of C1 inhibitor can cause angioedema since levels of complement are reduced and cause increased bradykinin. This can be due to lack of C1 INH or adequate amounts of nonfunctional C1 INH. Other causes of angioedema include aspirin and NSAIDs since inhibition of cox and enzyme pathyway increases formation of pro-inflammatory leukotrienes.
Other possibilities in the differential of causes of swelling include cellulitis, autoimmune conditions including SLE, polymyositis, dermatomyositis and sjorgren’s syndrome. Hypothyroidism can cuase puffiness of face and lips, hyperthyroidism can cause an infiltrative dermopathy, superior vena cava syndrome and tumors can cause venous engorgement and swelling. It is not likely one of these etiologies since the patient is on an ACEI and the swelling is restricted only to her tongue and throat typical of ACEI angioedema.
Plan:
++Swollen tongue:
• Give patient corticosteroid to decrease inflammation and to protect against relapse after initial improvement. 4 days of Dexamethasone 10 mg IV tid.
• Give patient antihistamine to block inflammation as well. 4 days of Diphenhydramine 25 mg bid.
• ENT consult to rule out abscess or foreign object
• Check C1 and C4 levels that would be | Swelling of Tongue, Difficulty Swallowing | Study Description |
77 yo woman presents with significant angioedema in left side of tongue and inner cheek. Possible causes of angioedema include allergic anaphylaxis reaction, drug induced, allergic contact dermatitis, viral infection, drug induced, or a C1 inhibitor deficiency disorder acquired or hereditary. Laryngeal edema can also be caused by tonsillitis, peritonsilar abscess or pharyngeal foreign body. | Patient Diagnoses | Angioedema Explanation |