Document:

EXHIBIT
      10.53

     

    INSITE
      VISION INCORPORATED

     

    AMENDED
      AND RESTATED SENIOR SECURED NOTE

     

    
      	
              $231,000

            	
              December
                30, 2005

            
	 	
              Alameda,
                California

            

    

     

    WHEREAS,
      InSite
      Vision Incorporated, a Delaware corporation (the “Maker” or the “Company”) and
      S. Kumar Chandrasekaran, Ph.D., (“Holder”) desire to amend and restate that
      certain Senior Secured Note dated as of July 15, 2003 in the manner set forth
      below;

     

    NOW
      THEREFORE,
      the
      Maker and the Holder agree as follows:

     

    FOR
      VALUE RECEIVED,
      Maker
      promises to pay to the order of Holder, at 14 Magee Court, Moraga, CA 94556,
      the
      principal sum of Two Hundred And Thirty One Thousand Dollars ($231,000.00),
      together with all accrued interest thereon from July 15, 2003, the date of
      the
      original issuance, upon the terms and conditions specified below.

     

    1. Loan
      Proceeds.
      The
      proceeds of this Note shall be used for general corporate purposes of the
      Maker.

     

    2. Interest.
      Interest
      shall accrue on the unpaid balance outstanding from time to time under this
      Note
      at the rate of five and one-half percent (5.5%) per annum. All computations
      of
      interest shall be made on the basis of a year of 365 days for the actual number
      of days (including the first day but excluding the last day) occurring in the
      period for which such interest is payable. Accrued
      and unpaid interest shall become due and payable at the maturity of the Note.
      

     

    3. Due
      Date.
      Unless
      earlier accelerated pursuant to the terms hereof, this Note shall mature and
      the
      outstanding principal balance of this Note together with all accrued interest
      hereunder shall become due and payable in a lump sum on the
      earlier to occur of: (a) March 31, 2007 and (b) within
      ten (10) days after the consummation of a Qualified Financing, a Sale of the
      Company or a Corporate Collaboration. 

     

    For
      purposes hereof, (i) “Qualified Financing” shall mean the closing of an equity
      financing or series of equity financings by the Company resulting in aggregate
      gross cash proceeds (before commissions or other expenses) to the Company of
      at
      least $12,500,000; and (ii) “Sale of the Company” shall mean a transaction (or
      series of related transactions) between the Company and one or more
      non-affiliates, pursuant to which such party or parties acquire (A) capital
      stock of the Company possessing the voting power to elect a majority of the
      board of directors of the Company (whether by merger, consolidation, sale or
      transfer of the Company’s capital stock or otherwise); or (B) all or
      substantially all of the Company’s assets determined on a consolidated basis;
      provided, however, that a transaction (or series of related transactions)
      pursuant to which the then-existing holders of the Company’s capital stock
      immediately prior to such transaction (or series of related transactions)
      continue to own, directly or indirectly, a majority of the outstanding shares
      of
      the capital stock of the Company or such other resulting, surviving or combined
      company resulting from such transaction (or series of related transactions)
      shall not be deemed to be a Sale of the Company and (iii) a “Corporate
      Collaboration” shall mean the closing by the Company of a transaction in which
      any rights to AzaSite are licensed to a third party.

     

    
      
         

      

      
         

        
          

        

      

      
         

      

    

     

    4. Payment.
      Payment
      shall be made in lawful tender of the United States and shall be applied first
      to the payment of all accrued and unpaid interest and then to the payment of
      principal. Prepayment of the principal balance of this Note, together with
      all
      accrued and unpaid interest on the portion of principal so prepaid, may be
      made
      in whole or in part at any time without penalty.

     

    5. Events
      of Acceleration.
      The
      entire unpaid principal balance of this Note, together with all accrued and
      unpaid interest, shall become immediately due and payable prior to the specified
      due date of this Note upon the occurrence of one or more of the following events
      (each an “Event of Acceleration”): 

     

    (a) Pursuant
      to or within the meaning of the United States Bankruptcy Code or any other
      federal or state law relating to insolvency or relief of debtors (a “Bankruptcy
      Law”), Maker shall (i) commence a voluntary case or proceeding; (ii) consent to
      the entry of an order for relief against it in an involuntary case; (iii)
      consent to the appointment of a trustee, receiver, assignee, liquidator or
      similar official; (iv) make an assignment for the benefit of its creditors;
      or
      (v) admit in writing its inability to pay its debts as they become due;

     

    (b) A
      court
      of competent jurisdiction enters an order or decree under any Bankruptcy Law
      that (i) is for relief against Maker in an involuntary case; (ii) appoints
      a
      trustee, receiver, assignee, liquidator or similar official for Maker or
      substantially all of Maker's properties; or (iii) orders the liquidation of
      Maker, and in each case the order or decree is not dismissed or stayed within
      30
      daysor; or

     

    (c) any
      "Event of Acceleration" or similar event of default under the 2005 Senior
      Secured Notes due June 30, 2006.

     

    6. Security.
      Payment
      of this Note shall be secured by a lien on substantially all of the Maker’s
      assets in accordance with that certain Amended and Restated Security Agreement
      (the “Security Agreement”) dated as of December 30, 2005 by and among the
      Collateral Agent an the other parties thereto. The Maker, however, shall remain
      liable for payment of this Note, and assets of the Maker, in addition to the
      collateral under the Security Agreement, may be applied to the satisfaction
      of
      the Maker’s obligations hereunder. In the case of any Event of Acceleration,
      Holder shall have the rights set forth herein and as set forth in the Security
      Agreement.

     

    7. Collection.
      If
      action
      is instituted to collect this Note, the Maker promises to pay all costs and
      expenses (including reasonable attorney fees) incurred in connection with such
      action.

     

    
      
         

      

      
        2.

        
          

        

      

      
         

      

    

     

    8. Waiver.
      A waiver
      of any term of this Note or of any of the obligations secured thereby must
      be
      made in writing and signed by Holder and any such waiver shall be limited to
      its
      express terms.

     

    No
      delay
      by Holder in acting with respect to the terms of this Note shall constitute
      a
      waiver of any breach, default, or failure of a condition under this Note or
      the
      obligations secured thereby. 

     

    The
      Maker
      waives presentment, demand, notice of dishonor, notice of default or
      delinquency, notice of acceleration, notice of protest and nonpayment, notice
      of
      costs, expenses or losses and interest thereon, notice of interest on interest
      and diligence in taking any action to collect any sums owing under this
      Note.

     

    9. Entire
      Agreement.
      In the
      event of any inconsistencies between the terms of this Note and the terms of
      any
      other document related to the loan evidenced by the Note, the terms of this
      Note
      shall prevail.

     

    10. Separate
      Counsel.
      In
      making the loan evidenced by this Note and by Holder’s acceptance of this Note,
      Holder hereby acknowledges that the law firm of O’Melveny & Myers LLP
      (“OMM”) has represented the Maker in the transaction contemplated by this Note
      and has not represented Holder or any of the other Holders in such transaction.
      Holder further acknowledges that Holder has had an adequate and meaningful
      opportunity to review and interpret this Note with separate legal counsel of
      Holder’s own choosing, other than lawyers at OMM, and
      to
      obtain appropriate tax and legal advice with respect of the implications and
      consequences of entering into such transactions.

     

    11. Governing
      Law.
      This
      Note shall be construed in accordance with the laws of the State of California
      without resort to that State’s conflict-of-laws rules.

     

    
      	 	
              INSITE
                VISION INCORPORATED

            
	 	
              __________________________________________

            
	 	
              By:
                _______________________________________

            
	 	
              Its:
                _______________________________________

            

    

    

     

    
      
         

      

      
        3.This
        AMENDMENT NO. 2 TO CREDIT AGREEMENT (this “Amendment”),
        dated
        as of February 14, 2006, is entered into by and between DIALYSIS CORPORATION
        OF
        AMERICA, a Florida corporation (herein, together with its successors and
        assigns, the “Borrower”),
        and
        KEYBANK NATIONAL ASSOCIATION, a national banking association (herein, together
        with its successors and assigns, the “Lender”).

       

      PRELIMINARY
        STATEMENTS:

       

      (1)     The
        Borrower and the Lender entered into the Credit Agreement, dated as of
        October 24, 2005 (as amended, the “Credit
        Agreement”;
        capitalized terms used herein and not defined herein are used herein as defined
        in the Credit Agreement).

       

      (2)     The
        parties
        hereto desire to modify certain terms and provisions of the Credit
        Agreement.

       

      NOW,
        THEREFORE, the parties hereto agree as follows:

       

      SECTION
        1.  AMENDMENT.
        Section
        6.3 of the Credit Agreement is hereby amended effective as of February 1,
        2006,
        by (1) deleting the period (“.”) from the end of clause (c) thereof and
        inserting a semicolon and the word “and” (“; and”) in its place and (2)
        inserting the following new clause (d) thereto:

       

      (d) Liens
        on
        the assets purchased by the Borrower to and as and to the extent described
        in
        the Asset Purchase Agreement, dated as of February 14, 2006 (and effective
        as of
        February 1, 2006), by and between DCA of Kilmarnock, LLC, a Subsidiary of
        the
        Borrower, and DVA Healthcare Renal Care, Inc. so long as the cost or fair
        market
        value of such assets does not at any time exceed $250,000.

       

      SECTION
        2.  REPRESENTATIONS
        AND WARRANTIES. The
        Borrower represents and warrants to the Lender as follows:

       

      2.1.  Authorization,
        Validity and Binding Effect.
        This
        Amendment has been duly authorized by all necessary corporate action on the
        part
        of the Borrower, has been duly executed and delivered by a duly authorized
        officer or officers of the Borrower, and constitutes the valid and binding
        agreement of the Borrower, enforceable against the Borrower in accordance
        with
        its terms.

       

      2.2.  Representations
        and Warranties True and Correct.
        The
        representations and warranties of the Borrower contained in the Credit
        Agreement, as amended hereby, are true and correct on and as of the date
        hereof
        as though made on and as of the date hereof, except to the extent that such
        representations and warranties expressly relate to a specified date, in which
        case such representations and warranties are hereby reaffirmed as true and
        correct when made.

       

      2.3.  No
        Event of Default.
        After
        giving effect to this Amendment, no condition or event has occurred or exists
        that constitutes or that, after notice or lapse of time or both, would
        constitute a Default or an Event of Default.

       

      
        
           

        

        
           

          
            

          

        

        
           

        

      

       

      2.4.  No
        Claims.
        The
        Borrower is not aware of any claim or offset against, or defense or counterclaim
        to, any of its obligations or liabilities under the Credit Agreement or any
        other Credit Document.

       

      SECTION
        3.  RATIFICATIONS.
        Except
        as
        expressly modified and superseded by this amendment, the terms and provisions
        of
        the Credit Agreement are ratified and confirmed and shall continue in full
        force
        and effect.

       

      SECTION
        4.  CONDITIONS
        PRECEDENT. The
        amendments set forth in Section 1 hereof shall become effective as of the
        date first written above if on or before the date hereof, the following
        conditions have been satisfied:

       

      (a)     this
        Amendment shall have been executed by the Borrower and the Lender, and
        counterparts hereof as so executed shall have been delivered to the
        Lender;

       

      (b)     the
        Borrower shall have caused each Guarantor to consent and agree to and
        acknowledge the terms of this Amendment; and

       

      (c)     the
        Borrower
        shall have provided such other items and shall have satisfied such other
        conditions as may be reasonably required by the Lender.

       

      SECTION
        5.  MISCELLANEOUS.

       

      5.1.  Successors
        and Assigns.
        This
        Amendment shall be binding upon and inure to the benefit of the Borrower
        and the
        Lender and their respective successors and assigns.

       

      5.2.  Survival
        of Representations and Warranties.
        All
        representations and warranties made in this Amendment shall survive the
        execution and delivery of this Amendment, and no investigation by the Lender
        or
        any subsequent Loan shall affect the representations and warranties or the
        right
        of the Lender to rely upon them.

       

      5.3.  Reference
        to Credit Agreement.
        The
        Credit Agreement and any and all other agreements, instruments or documentation
        now or hereafter executed and delivered pursuant to the terms of the Credit
        Agreement as amended hereby, are hereby amended so that any reference therein
        to
        the Credit Agreement shall mean a reference to the Credit Agreement as amended
        hereby.

       

      5.4.  Expenses.
        As
        provided in the Credit Agreement, but without limiting any terms or provisions
        thereof, the Borrower agrees to pay on demand all costs and expenses incurred
        by
        the Lender in connection with the preparation, negotiation, and execution
        of
        this Amendment, including without limitation the costs and fees of the Lender’s
        special legal counsel, regardless of whether this Amendment becomes effective
        in
        accordance with the terms hereof, and all costs and expenses incurred by
        the
        Lender in connection with the enforcement or preservation of any rights under
        the Credit Agreement, as amended hereby.

       

      5.5.  Severability.
        Any
        term or provision of this Amendment held by a court of competent jurisdiction
        to
        be invalid or unenforceable shall not impair or invalidate the remainder
        of this
        Amendment and the effect thereof shall be confined to the term or provision
        so
        held to be invalid or unenforceable.

       

      
        
           

        

        
           

          
            

          

        

        
           

        

      

       

      5.6.  Applicable
        Law.
        This
        Amendment shall be governed by and construed in accordance with the laws
        of the
        State of Ohio, without regard to principles of conflicts of laws.

       

      5.7.  Headings.
        The
        headings, captions and arrangements used in this Amendment are for convenience
        only and shall not affect the interpretation of this Amendment.

       

      5.8.  Entire
        Agreement.
        This
        Amendment is specifically limited to the matters expressly set forth herein.
        This Amendment and all other instruments, agreements and documentation executed
        and delivered in connection with this Amendment embody the final, entire
        agreement among the parties hereto with respect to the subject matter hereof
        and
        supersede any and all prior commitments, agreements, representations and
        understandings, whether written or oral, relating to the matters covered
        by this
        Amendment, and may not be contradicted or varied by evidence of prior,
        contemporaneous or subsequent oral agreements or discussions of the parties
        hereto. There are no oral agreements among the parties hereto relating to
        the
        subject matter hereof or any other subject matter relating to the Credit
        Agreement.

       

      5.9.  Waiver
        of Claims.
        The
        Borrower, by signing below, hereby waives and releases the Lender and its
        directors, officers, employees, attorneys, affiliates and subsidiaries from
        any
        and all claims, offsets, defenses and counterclaims of which Borrower is
        aware,
        such waiver and release being with full knowledge and understanding of the
        circumstances and effect thereof and after having consulted legal counsel
        with
        respect thereto.

       

      5.10.  Counterparts.
        This
        Amendment may be executed by the parties hereto separately in one or more
        counterparts, each of which when so executed shall be deemed to be an original,
        but all of which when taken together shall constitute one and the same
        agreement. Transmission by a party to another party (or its counsel) via
        facsimile or electronic mail of a copy of this Amendment (or a signature
        page of
        this Amendment) shall be as fully effective as delivery by such transmitting
        party to the other parties hereto of a counterpart of this Amendment that
        had
        been manually signed by such transmitting party.

       

      5.11.  JURY
        TRIAL WAIVER.
        THE
        BORROWER AND THE LENDER EACH WAIVES ANY RIGHT TO HAVE A JURY PARTICIPATE
        IN
        RESOLVING ANY DISPUTE, WHETHER SOUNDING IN CONTRACT, TORT OR OTHERWISE, BETWEEN
        THE BORROWER AND THE LENDER, ARISING OUT OF, IN CONNECTION WITH, RELATED
        TO, OR
        INCIDENTAL TO THE RELATIONSHIP ESTABLISHED BETWEEN THEM IN CONNECTION WITH
        THIS
        AMENDMENT, THE CREDIT AGREEMENT, THE NOTE OR OTHER RELATED WRITING, INSTRUMENT,
        DOCUMENT OR AGREEMENT EXECUTED OR DELIVERED IN CONNECTION HEREWITH OR THE
        TRANSACTIONS RELATED THERETO.

       

      [Remainder
        of page intentionally left blank.]

       

      
        
          
             

          

          
             

            
              

            

          

          
             

          

        

      

      

      IN
        WITNESS WHEREOF, this Amendment has been duly executed and delivered as of
        the
        date first above written.

       

      

      
        	 	
                BORROWER:

                 

                DIALYSIS
                  CORPORATION OF AMERICA

                 

                By:
                  

                Name:
                   Stephen
                  W. Everett

                Title:
                   President
                  and Chief Executive Officer

                 

              
	 	
                LENDER:

                 

                KEYBANK
                  NATIONAL ASSOCIATION

                 

                By:
                  

                Name:
                   J.T.
                  Taylor

                Title:
                   Senior
                  Vice President

                 

              

      

      

        
          
             

          

          
             

            
              

            

          

          
             

            
              

            

          

        

      

       

      GUARANTOR
        ACKNOWLEDGMENT AND AGREEMENT

      

      Each
        of
        the undersigned consents and agrees to and acknowledges the terms of the
        foregoing Amendment No. 2 to Credit Agreement, dated as of February ___,
        2006.
        Each of the undersigned specifically acknowledges the terms of and consent
        to
        the waivers set forth therein. Each of the undersigned further agrees that
        the
        obligations of each of the undersigned pursuant to the Closing Date Guaranty
        executed by each of the undersigned shall remain in full force and effect
        and be
        unaffected hereby. 

       

      Each
        of
        the undersigned, by signing below, hereby waives and releases the Lender
        and its
        respective directors, officers, employees, attorneys, affiliates and
        subsidiaries from any and all claims, offsets, defenses and counterclaims
        of
        which any of the undersigned is aware, such waiver and release being with
        full
        knowledge and understanding of the circumstances and effect thereof and after
        having consulted legal counsel with respect thereto.

       

      EACH
        OF
        THE UNDERSIGNED WAIVES ANY RIGHT TO HAVE A JURY PARTICIPATE IN RESOLVING
        ANY
        DISPUTE, WHETHER SOUNDING IN CONTRACT, TORT OR OTHERWISE, AMONG ANY OF THE
        UNDERSIGNED, THE BORROWER AND/OR THE LENDER, ARISING OUT OF, IN CONNECTION
        WITH,
        RELATED TO, OR INCIDENTAL TO THE RELATIONSHIP ESTABLISHED AMONG THEM IN
        CONNECTION WITH THIS AGREEMENT, THE CREDIT AGREEMENT, THE NOTE OR OTHER RELATED
        WRITING, INSTRUMENT, DOCUMENT OR AGREEMENT EXECUTED OR DELIVERED IN CONNECTION
        HEREWITH OR THE TRANSACTIONS RELATED THERETO.

       

      IN
        WITNESS WHEREOF, each of the undersigned has duly executed and delivered
        this
        Guarantor Acknowledgement and Agreement as of the date first written
        above.

       

      DCA
        Medical Services, Inc.

      DCA
        of
        Adel, LLC

      DCA
        of
        Calhoun, LLC

      DCA
        of
        Central Valdosta, LLC

      DCA
        of
        Fitzgerald, LLC

      DCA
        of
        Hawkinsville, LLC

      DCA
        of
        So. Ga., LLC

      DCA
        of
        Royston, LLC

      DCA
        of
        Rockville, LLC

      DCA
        of
        Norwood, LLC

      DCA
        of
        Lemoyne, Inc.

      DCA
        of
        Mechanicsburg, LLC

      DCA
        of
        Wellsboro, Inc.

      Keystone
        Kidney Care, Inc.

      DCA
        of
        Warsaw, LLC

      DCA
        of
        Aiken, LLC

      DCA
        of
        Aiken II, LLC

      DCA
        of
        Barnwell, LLC

      DCA
        of
        Edgefield, LLC

       

      By:_______________________________________
        

      
        Name: Stephen
          W. Everett

      

      
        Title:
          President
          of each of the foregoing Guarantors

      

      

        
          
             

          

          
             

            
              

            

          

          
             

            
              

            

          

        

        
          

        

      

      
        
          

        

         

      

      

      DIALYSIS
        CORPORATION OF AMERICA

      as
        the Borrower,

      

      and

      

      KEYBANK
        NATIONAL ASSOCIATION,

      as
        the Lender

      

      

      _____________________

      

      AMENDMENT
        NO. 2

      to

      CREDIT
        AGREEMENT

      dated
        as
        of

      February
        14, 2006

      _____________________

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