Document:

Exhibit
10.5

 

NOTE
PURCHASE AGREEMENT

 

NOTE
PURCHASE AGREEMENT (the “Agreement”), dated as of November 3, 2019, by and among PAVmed Inc., a Delaware
corporation with offices located at One Grand Central Place, Suite 4600, New York, NY 10165 (the “Company”)
and the investor signatory hereto (the “Investor”).

 

WHEREAS:

 

A.
Concurrently herewith, the Company and the Investor has entered into that certain Securities Purchase Agreement, dated November
3, 2019, pursuant to which, among other things, the Investor shall acquire a senior secured convertible note (the “Series
B Note”) of the Company (the “Securities Purchase Agreement”).

 

B.
The Company and the Investor is executing and delivering this Agreement in reliance upon the exemption from securities registration
afforded by Section 4(a)(2) of the Securities Act of 1933, as amended (the “1933 Act”), as promulgated by the
United States Securities and Exchange Commission (the “SEC”) under the 1933 Act.

 

C.
The Investor has authorized the issuance of a new secured promissory Investor Note in substantially the form attached hereto as
Exhibit A, pursuant to the terms set forth herein (collectively, the “Investor Note”).

 

D.
The Investor wishes to purchase the Series B Note from the Company pursuant to the Securities Purchase Agreement and to issue
the Investor Note in full satisfaction, of the purchase price of the Series B Note (the “Series B Purchase Price”),
and the Company wishes to (x) sell the Series B Note to the Investor, (y) acquire the Investor Note in full satisfaction of the
Series B Purchase Price and (z) pledge the Investor Note to the Investor as collateral for its obligations under the Series B
Note.

 

E.
The Investor Note will be secured by a first priority security interest in certain Eligible Assets (as defined in the Investor
Note) (collectively, the “Collateral”) held in the collateral account of the Investor described in the Investor
Note (the “Collateral Account”).

 

F.
Concurrently herewith, each of the Company and the Investor are entering into that certain Master Netting Agreement, in substantially
the form attached hereto as Exhibit B (the “Master Netting Agreement”), to provide further clarification
of its right (but not, in the case of Investor only, its obligation) to Net (as defined below) certain Obligations (as defined
in the Netting Agreement) arising under and across this Agreement, the Investor Note, the Series B Notes and the Securities Purchase
Agreement (collectively, the “Underlying Agreements”) and to treat the Master Netting Agreement, this Agreement
and the other Underlying Agreements as a single agreement for the purposes set forth herein and this Agreement and the Securities
Purchase Agreement each as a “securities contract” (11 U.S.C. § 741), or other similar agreements.

 

    	 	 	 

    	 

    

 

NOW,
THEREFORE, the Company and the Investor hereby agree as follows:

 

1.
PURCHASE AND SALE OF INVESTOR NOTE.

 

(a)
Investor Note. Subject to the satisfaction (or waiver) of the conditions set forth in Sections 5 and 6 below, the Investor
agrees to issue and sell to the Company, and the Company agrees to purchase from the Investor on the Closing Date (as defined
below), such aggregate principal amount of Investor Note as is set forth on the signature page of the Investor attached hereto
in full satisfaction of the Series B Purchase Price under the Securities Purchase Agreement (the “Closing”).

 

(b)
Closing. The Closing of the purchase of the Investor Note by the Company shall occur at the offices of Kelley Drye &
Warren LLP, 101 Park Avenue, New York, NY 10178. The date and time of the Closing (the “Closing Date”) shall
be 10:00 a.m., New York time, on the first (1st) Business Day on which the conditions to the Closing set forth in Sections 5 and
6 below are satisfied or waived (or such other date or time as is mutually agreed to by the Company and the Investor). As used
herein “Business Day” means any day other than a Saturday, Sunday or other day on which commercial banks in
New York, New York are authorized or required by law to remain closed.

 

(c)
Delivery of Investor Note in Satisfaction of Series B Purchase Price; Securities Contract; Netting Safe Harbor. On the
Closing Date, the Investor shall duly execute the Investor Note, registered in the name of the Company, in full satisfaction of
the Series B Purchase Price pursuant to the Securities Purchase Agreement, and, in accordance with the instructions of the Company
in the Flow of Funds Letter (as defined in the Securities Purchase Agreement), the Investor shall maintain physical possession
of the Investor Note as Collateral (as defined in the Series B Note) securing the Series B Note. For the avoidance of doubt, the
Investor Note is deemed simultaneously delivered (x) by the Investor to the Company at the Closing hereunder and (y) delivered
by the Company to the Investor at the Closing (as defined in the Securities Purchase Agreement) under the Securities Purchase
Agreement, as Collateral for the Series B Note purchased by the Investor thereunder. Other than the issuance of the Series B Note
to the Investor pursuant to the Securities Purchase Agreement, the Company shall not be required to pay any additional consideration
for the issuance of the Investor Note hereunder. The Company hereby acknowledges and agrees that the rights and obligations of
the Investor under the Master Netting Agreement, hereunder and under the other Underlying Agreements and the rights and obligations
of the Company under the Master Netting Agreement, hereunder and under the other Underlying Agreements arise in a single integrated
transaction and constitute related and interdependent obligations within such transaction. The Company and the Investor hereby
acknowledge and agree that this Agreement and the Securities Purchase Agreement each is a “securities contract” as
defined in 11 U.S.C. § 741 and that Investor shall have all rights in respect of the Master Netting Agreement, this Agreement
and the other Underlying Agreements as are set forth in 11 U.S.C. § 555 and 11 U.S.C. § 362(b)(6), including, without
limitation, all rights of credit, deduction, setoff, offset, recoupment, and netting (collectively, “Netting”)
as are available under the Master Netting Agreement, this Agreement and the other Underlying Agreements, and all Netting provisions
of the Series B Note, the Master Netting Agreement and the Investor Note, including without limitation the provisions set forth
in Section 7 of the Investor Note, are hereby incorporated in this Agreement and made a part hereof as if such provisions were
set forth herein.

 

    	 	- 2 -	 

    	 

    

 

2.
COMPANY’S REPRESENTATIONS AND WARRANTIES.

 

The
Company represents and warrants, as of the date hereof and as of the Closing Date in which the Company is purchasing the Investor
Note hereunder, that:

 

(a)
Securities Purchase Agreement. The representations and warranties of the Company set forth in the Securities Purchase Agreement
are hereby incorporated by reference herein, mutatis mutandis.

 

(b)
No Sale or Distribution. The Company is acquiring the Investor Note for its own account and not with a view towards, or
for resale in connection with, the public sale or distribution thereof. The Company does not presently have any agreement or understanding,
directly or indirectly, with any Person (as defined in the Securities Purchase Agreement) to distribute any of the Investor Note.

 

(c)
Sophisticated Investor. The Company is a sophisticated investor (as described in Rule 506(b)(2)(ii) of Regulation D), and
has such knowledge and experience in business and financial matters that it is capable of evaluating the merits and risks of an
investment in the Investor Note.

 

(d)
Reliance on Exemptions. The Company understands that the Investor Note is being offered and sold to it in reliance on specific
exemptions from the registration requirements of United States federal and state securities laws and that the Investor is relying
in part upon the truth and accuracy of, and the Company’s compliance with, the representations, warranties, agreements,
acknowledgments and understandings of the Company set forth herein in order to determine the availability of such exemptions and
the eligibility of the Company to acquire the Investor Note.

 

(e)
Information. The Company and its advisors, if any, have been furnished with all materials relating to the business, finances
and operations of the Investor and materials relating to the offer and sale of the Investor Note that have been requested by the
Company. The Company and its advisors, if any, have been afforded the opportunity to ask questions of the Investor. Neither such
inquiries nor any other due diligence investigations conducted by the Company or its advisors, if any, or its representatives
shall modify, amend or affect the Company’s right to rely on the Investor’s representations and warranties contained
herein. The Company understands that its investment in the Investor Note involves a high degree of risk. The Company has sought
such accounting, legal and tax advice as it has considered necessary to make an informed investment decision with respect to its
acquisition of the Investor Note.

 

(f)
No Governmental Review. The Company understands that no United States federal or state agency or any other government or
governmental agency has passed on or made any recommendation or endorsement of the Investor Note or the fairness or suitability
of the investment in the Investor Note nor have such authorities passed upon or endorsed the merits of the offering of the Investor
Note.

 

(g)
Transfer or Resale. The Company understands that: (i) the Investor Note has not been and is not being registered under
the 1933 Act or any state securities laws, and may not be offered for sale, sold, assigned or transferred without the consent
of the Investor (and any Prohibited Transfer (as defined in the Investor Note) shall be subject to certain recoupment rights and
netting against the Series B Note to be issued to the Investor concurrently with the Closing hereunder) and (ii) neither the Investor
nor any other Person is under any obligation to register the Investor Note under the 1933 Act or any state securities laws or
to comply with the terms and conditions of any exemption thereunder.

 

    	 	- 3 -	 

    	 

    

 

(h)
Legends. The Company understands that the certificates or other instruments representing the Investor Note shall bear any
legend as required by the “blue sky” laws of any state and a restrictive legend in substantially the following form
(and a stop-transfer order may be placed against transfer of such stock certificates):

 

THIS
NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE APPLICABLE STATE SECURITIES
LAWS, AND MAY NOT BE OFFERED OR SOLD IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT AND SUCH STATE SECURITIES
LAWS, OR AN EXEMPTION FROM REGISTRATION THEREUNDER, IN EACH CASE, TO THE EXTENT APPLICABLE HERETO.

 

3.
REPRESENTATIONS AND WARRANTIES OF THE INVESTOR.

 

The
Investor represents and warrants to the Company as of the date hereof and as of the Closing Date as follows:

 

(a)
Securities Purchase Agreement. The representations and warranties of the Investor set forth in the Securities Purchase
Agreement are hereby incorporated by reference herein, mutatis mutandis.

 

(b)
Authorization; Enforcement; Validity. The Investor has the requisite corporate power and authority to enter into and perform
its obligations under this Agreement and the Investor Note and each of the other agreements entered into by the parties hereto
in connection with the transactions contemplated by this Agreement (collectively, the “Transaction Documents”)
and to issue the Investor Note in accordance with the terms hereof and thereof. The execution and delivery of the Transaction
Documents by the Investor and the consummation by the Investor of the transactions contemplated hereby and thereby, including,
without limitation, the issuance of the Investor Note has been duly authorized by the Investor’s board of directors, investment
manager or other governing body and no further filing, consent, or authorization is required by the Investor. This Agreement and
the other Transaction Documents have been duly executed and delivered by the Investor, and constitute the legal, valid and binding
obligations of the Investor, enforceable against the Investor in accordance with their respective terms, except as such enforceability
may be limited by general principles of equity or applicable bankruptcy, insolvency, reorganization, moratorium, liquidation or
similar laws relating to, or affecting generally, the enforcement of applicable creditors’ rights and remedies.

 

(c)
Issuance of Investor Note. The issuance of the Investor Note is duly authorized and upon issuance in accordance with the
terms of the Transaction Documents shall be free from all taxes, liens and charges with respect to the issue thereof. Assuming
the accuracy of each of the representations and warranties set forth in Section 2 of this Agreement, the offer and issuance by
the Investor of the Investor Note is exempt from registration under the 1933 Act.

 

    	 	- 4 -	 

    	 

    

 

(d)
No Conflicts. The execution, delivery and performance of the Transaction Documents by the Investor and the consummation
by the Investor of the transactions contemplated hereby and thereby (including, without limitation, the issuance of the Investor
Note) will not (i) result in a violation of the Investor’s organizational documents or (ii) conflict with, or constitute
a default (or an event which with notice or lapse of time or both would become a default) in any respect under, or give to others
any rights of termination, amendment, acceleration or cancellation of, any agreement, indenture or instrument to which the Investor
is a party, or (iii) result in a violation of any law, rule, regulation, order, judgment or decree (including foreign, federal
and state securities laws and regulations) applicable to the Investor or by which any property or asset of the Investor is bound
or affected, except, in the case of clause (ii) and (iii) above, for such violations, conflicts, breaches, defaults, losses, terminations
of rights thereof, or accelerations which, in the aggregate, would not reasonably be expected to have a Material Adverse Effect
(as defined below). “Material Adverse Effect” means any material adverse effect on (i) the business, properties,
assets, liabilities, operations (including results thereof) or condition (financial or otherwise) of the Investor, (ii) the transactions
contemplated hereby or in any of the other Transaction Documents or (iii) the authority or ability of the Company or any of its
Subsidiaries (as defined in the Securities Purchase Agreement) to perform any of their respective obligations under any of the
Transaction Documents.

 

(e)
Consents. The Investor is not required to obtain any consent, authorization or order of, or make any filing or registration
with, any government, court, regulatory, self-regulatory, administrative agency or commission or other governmental agency, authority
or instrumentality, domestic or foreign, of competent jurisdiction (a “Governmental Authority”) or any other
Person in order for it to execute, deliver or perform any of its obligations under or contemplated by the Transaction Documents,
in each case in accordance with the terms hereof or thereof. The Investor is unaware of any facts or circumstances that might
prevent the Investor from obtaining or effecting any of the registration, application or filings pursuant to the preceding sentence.

 

(f)
No General Solicitation. The Investor has not engaged in any form of general solicitation or general advertising (within
the meaning of Regulation D) in connection with the offer or sale of the Investor Note.

 

(g)
No Integrated Offering. Neither the Investor nor any Person acting on its behalf has, directly or indirectly, made any
offers or sales of any security or solicited any offers to buy any security, under circumstances that would require registration
of the issuance of the Investor Note under the 1933 Act, whether through integration with prior offerings or otherwise. Neither
the Investor nor any Person acting on their behalf will take any action or steps referred to in the preceding sentence that would
require registration of the issuance of any of the Investor Note under the 1933 Act.

 

(h)
Sufficient Collateral. As of the Closing Date the bank account described on Schedule I to the Investor Note, which contains
the Collateral that secures the Investor Note in accordance therewith, contains at least the Series B Purchase Price of Eligible
Assets as of the Closing Date, and the Eligible Assets have not been pledged to secure any other obligation of the Investor or
any other Person.

 

    	 	- 5 -	 

    	 

    

 

(i)
Full Recourse. The Investor Note is a full recourse obligation of the Investor.

 

4.
COVENANTS.

 

(a)
Reasonable Best Efforts. Each party shall use its reasonable best efforts timely to satisfy each of the conditions to be
satisfied by it as provided in Sections 5 and 6 of this Agreement.

 

(b)
Fees. The Company shall be responsible for the payment of any placement agent’s fees, financial advisory fees, or
broker’s commissions relating to or arising out of the transactions contemplated hereby. The Company shall pay, and hold
the Investor harmless against, any liability, loss or expense (including, without limitation, reasonable attorney’s fees
and out-of-pocket expenses) arising in connection with any claim relating to any such payment. Except as otherwise set forth in
the Transaction Documents or the Securities Purchase Agreement, each party to this Agreement shall bear its own expenses in connection
with the sale of the Investor Note to the Investors.

 

(c)
Taxes. The Company will pay, and save and hold the Investor harmless from any and all liabilities (including interest and
penalties) with respect to, or resulting from any delay or failure in paying, stamp and other taxes (other than income taxes),
if any, which may be payable or determined to be payable on the execution and delivery or acquisition of the Investor Note.

 

5.
CONDITIONS TO THE INVESTOR’S OBLIGATION TO SELL. The obligation of the Investor hereunder to issue and sell the Investor
Note to the Company at the Closing is subject to the satisfaction, at or before the Closing Date, of each of the following conditions,
provided that these conditions are for the Investor’s sole benefit and may be waived by the Investor at any time in its
sole discretion by providing the Company with prior written notice thereof:

 

(a)
The Company shall have executed each of the Transaction Documents to which it is a party and delivered the same to the Investor.

 

(b)
All conditions to the Investor’s closing of the transactions contemplated by the Securities Purchase Agreement shall have
been satisfied (except for such conditions waived by the Investor) and the Investor Note is being issued hereunder in full satisfaction
of the Series B Purchase Price.

 

(c)
The representations and warranties of the Company shall be true and correct in all material respects as of the date when made
and as of the Closing Date as though made at that time (except for representations and warranties that speak as of a specific
date, which shall be true and correct as of such specified date), and the Company shall have performed, satisfied and complied
in all material respects with the covenants, agreements and conditions required by this Agreement to be performed, satisfied or
complied with by the Company at or prior to the Closing Date.

 

    	 	- 6 -	 

    	 

    

 

6.
CONDITIONS TO THE COMPANY’S OBLIGATION TO PURCHASE. The obligation of the Company hereunder to purchase the Investor
Note at the Closing in satisfaction, in full, of the Series B Purchase Price is subject to the satisfaction, at or before the
Closing Date, of each of the following conditions, provided that these conditions are for the Company’s sole benefit and
may be waived by the Company at any time in its sole discretion by providing the Investor with prior written notice thereof:

 

(a)
The Investor shall have duly executed and delivered to the Company (A) each of the Transaction Documents and (B) the Investor
Note.

 

(b)
All conditions to the Company’s closing of the transactions contemplated by the Securities Purchase Agreement shall have
been satisfied (except for such conditions waived by the Company) and the Investor Note is being issued hereunder in full satisfaction
of the Series B Purchase Price.

 

(c)
The representations and warranties of the Investor shall be true and correct in all material respects as of the date when made
and as of the Closing Date as though made at that time (except for representations and warranties that speak as of a specific
date, which shall be true and correct as of such specified date), and the Investor shall have performed, satisfied and complied
in all material respects with the covenants, agreements and conditions required by this Agreement to be performed, satisfied or
complied with by the Investor at or prior to the Closing Date.

 

(d)
The Investor shall have obtained all governmental, regulatory or third party consents and approvals, if any, necessary for the
sale of the Investor Note.

 

7.
TERMINATION.

 

In
the event that the Closing shall not have occurred on or prior to the termination of the Securities Purchase Agreement, this Agreement
shall automatically terminate.

 

8.
MISCELLANEOUS.

 

(a)
Governing Law; Jurisdiction; Jury Trial. All questions concerning the construction, validity, enforcement and interpretation
of this Agreement shall be governed by the internal laws of the State of New York, without giving effect to any choice of law
or conflict of law provision or rule (whether of the State of New York or any other jurisdictions) that would cause the application
of the laws of any jurisdictions other than the State of New York. Each party hereby irrevocably submits to the exclusive jurisdiction
of the state and federal courts sitting in The City of New York, Borough of Manhattan, for the adjudication of any dispute hereunder
or in connection herewith or with any transaction contemplated hereby or discussed herein, and hereby irrevocably waives, and
agrees not to assert in any suit, action or proceeding, any claim that it is not personally subject to the jurisdiction of any
such court, that such suit, action or proceeding is brought in an inconvenient forum or that the venue of such suit, action or
proceeding is improper. Each party hereby irrevocably waives personal service of process and consents to process being served
in any such suit, action or proceeding by mailing a copy thereof to such party at the address for such notices to it under this
Agreement and agrees that such service shall constitute good and sufficient service of process and notice thereof. Nothing contained
herein shall be deemed to limit in any way any right to serve process in any manner permitted by law. EACH PARTY HEREBY IRREVOCABLY
WAIVES ANY RIGHT IT MAY HAVE TO, AND AGREES NOT TO REQUEST, A JURY TRIAL FOR THE ADJUDICATION OF ANY DISPUTE HEREUNDER OR IN CONNECTION
WITH OR ARISING OUT OF THIS AGREEMENT OR ANY TRANSACTION CONTEMPLATED HEREBY.

 

    	 	- 7 -	 

    	 

    

 

(b)
Counterparts. This Agreement may be executed in two or more identical counterparts, all of which shall be considered one
and the same agreement and shall become effective when counterparts have been signed by each party and delivered to the other
party. In the event that any signature is delivered by facsimile transmission or by an e-mail which contains a portable document
format (.pdf) file of an executed signature page, such signature page shall create a valid and binding obligation of the party
executing (or on whose behalf such signature is executed) with the same force and effect as if such signature page were an original
thereof.

 

(c)
Headings; Gender. The headings of this Agreement are for convenience of reference and shall not form part of, or affect
the interpretation of, this Agreement. Unless the context clearly indicates otherwise, each pronoun herein shall be deemed to
include the masculine, feminine, neuter, singular and plural forms thereof. The terms “including,” “includes,”
“include” and words of like import shall be construed broadly as if followed by the words “without limitation.”
The terms “herein,” “hereunder,” “hereof” and words of like import refer to this entire Agreement
instead of just the provision in which they are found.

 

(d)
Severability. If any provision of this Agreement shall be invalid or unenforceable in any jurisdiction, such invalidity
or unenforceability shall not affect the validity or enforceability of the remainder of this Agreement in that jurisdiction or
the validity or enforceability of any provision of this Agreement in any other jurisdiction.

 

(e)
Entire Agreement; Amendments. This Agreement, the Securities Purchase Agreement, the other Transaction Documents (as defined
herein) and the Transaction Documents (as defined in the Securities Purchase Agreement) and the schedules and exhibits attached
hereto and thereto and the instruments referenced herein and therein supersede all other prior oral or written agreements between
the Investors, the Company, its Subsidiaries, their affiliates and Persons acting on their behalf solely with respect to the matters
contained herein and therein, and this Agreement, the other Transaction Documents (as defined herein) and the Transaction Documents
(as defined in the Securities Purchase Agreement), the schedules and exhibits attached hereto and thereto and the instruments
referenced herein and therein contain the entire understanding of the parties solely with respect to the matters covered herein
and therein; provided, however, nothing contained in this Agreement or any other Transaction Document or the Transaction Documents
(as defined in the Securities Purchase Agreement) shall (or shall be deemed to) (i) have any effect on any agreements the Investor
has entered into with the Company or any of its Subsidiaries prior to the date hereof with respect to any prior investment made
by the Investor in the Company or (ii) waive, alter, modify or amend in any respect any obligations of the Company or any of its
Subsidiaries, or any rights of or benefits to the Investor or any other Person, in any agreement entered into prior to the date
hereof between or among the Company and/or any of its Subsidiaries and the Investor and all such agreements shall continue in
full force and effect. Except as specifically set forth herein or therein, neither the Company nor the Investor makes any representation,
warranty, covenant or undertaking with respect to such matters. For clarification purposes, the Recitals are part of this Agreement.
No provision of this Agreement may be amended or waived other than by an instrument in writing signed by the Company, the Investor
and the Required Holders.

 

    	 	- 8 -	 

    	 

    

 

(f)
Notices. Any notices, consents, waivers or other communications required or permitted to be given under the terms of this
Agreement shall be governed by the provisions of Section 9(f) of the Securities Purchase Agreement.

 

(g)
Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the parties and their respective
successors and assigns. No party may assign this Agreement or any rights or obligations hereunder without the prior written consent
of the other party.

 

(h)
No Third Party Beneficiaries. This Agreement is intended for the benefit of the parties hereto and their respective permitted
successors and assigns, and is not for the benefit of, nor may any provision hereof be enforced by, any other Person.

 

(i)
Survival. The representations, warranties, agreements and covenants shall survive each Closing. The Investor shall be responsible
only for its own representations, warranties, agreements and covenants hereunder.

 

(j)
Further Assurances. Each party shall do and perform, or cause to be done and performed, all such further acts and things,
and shall execute and deliver all such other agreements, certificates, instruments and documents, as any other party may reasonably
request in order to carry out the intent and accomplish the purposes of this Agreement and the consummation of the transactions
contemplated hereby.

 

(k)
Construction. The language used in this Agreement will be deemed to be the language chosen by the parties to express their
mutual intent, and no rules of strict construction will be applied against any party.

 

[Signature
Page Follows]

 

    	 	- 9 -	 

    	 

    

 

IN
WITNESS WHEREOF, the Investor and the Company have caused their respective signature page to this Note Purchase Agreement
to be duly executed as of the date first written above.

 

	 	COMPANY:
	 	 
	 	PAVMED
    INC.
	 	 	 
	 	By:	          
	 	Name:	 
	 	Title:	 

 

    	 	 	 

    	 

    

 

IN
WITNESS WHEREOF, the Investor and the Company have caused their respective signature page to this Note Purchase Agreement
to be duly executed as of the date first written above.

 

	 	INVESTOR:
	 	 
	 	Alto
    Opportunity Master Fund, SPC - Segregated Master Portfolio B
	 	 	 
	 	By:	                
	 	Name:	 
	 	Title:	 
	 	 	 
	 	Aggregate
    Principal Amount of Investor Note:
	 	 	 
	 	$3,150,000

 

    	 	 	 

    	 

    

 

IN
WITNESS WHEREOF, the Investor and the Company have caused their respective signature page to this Note Purchase Agreement
to be duly executed as of the date first written above.

 

	 	INVESTOR:
	 	 
	 	Alto
    Opportunity Master Fund, SPC - Segregated Master Portfolio C
	 	 	 
	 	By:	                
	 	Name:	 
	 	Title:	 
	 	 	 
	 	Aggregate
    Principal Amount of Investor Note: 
	 	 
	 	$3,150,000Exhibit
10.6

 

THIS
NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR THE APPLICABLE STATE SECURITIES
LAWS, AND MAY NOT BE OFFERED OR SOLD IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT AND SUCH STATE SECURITIES
LAWS, OR AN EXEMPTION FROM REGISTRATION THEREUNDER, IN EACH CASE, TO THE EXTENT APPLICABLE HERETO.

 

SECURED
PROMISSORY NOTE

 

	 	New
    York, New York
	$3,150,000	November
    4, 2019

 

FOR
VALUE RECEIVED, Alto Opportunity Master Fund, SPC - Segregated Master Portfolio [B][C] (the “Investor”) hereby
promises to pay to PAVmed Inc., a Delaware corporation (the “Company”), on the date set forth below, (i) the
principal amount of Three Million and One Hundred and Fifty Thousand Dollars ($3,150,000) and (ii) interest on the unpaid principal
balance hereof at the rate set forth herein (collectively, the “Obligations”). This Promissory Note (this “Note”)
has been issued pursuant to the Note Purchase Agreement, dated as of November 3, 2019 (the “Subscription Date”),
by and among the Company and the Investor (as amended, modified, supplemented, extended, renewed, restated or replaced from time
to time, the “Note Purchase Agreement”) as payment of the purchase price of that certain Series B Senior Secured
Convertible Note of the Company, with an initial aggregate principal amount of $3,500,000 (as such note may be amended, modified,
supplemented, extended, renewed, restated or replaced from time to time in accordance with the terms thereof, the “Series
B Note”), issued pursuant to that certain Securities Purchase Agreement, dated as of November 3, 2019 by and among the
Company and the investors party thereto (as amended, modified, supplemented, extended, renewed, restated or replaced from time
to time, the “Securities Purchase Agreement”). Capitalized terms not defined herein shall have the meaning
as set forth in the Series B Note. NEITHER THIS NOTE NOR ANY INTEREST HEREIN MAY BE PLEDGED, ASSIGNED OR OTHERWISE TRANSFERRED,
WHETHER BY THE COMPANY, OPERATION OF LAW, COURT ORDER OR OTHERWISE, WITHOUT THE EXPRESS PRIOR WRITTEN CONSENT OF THE INVESTOR.
ANY SUCH PURPORTED ASSIGNMENT OR TRANSFER WITHOUT SUCH CONSENT SHALL BE NULL AND VOID.

 

1.
Payment of Principal. The principal amount of this Note (the “Principal”), together with all unpaid
interest accrued thereon and any other Obligations payable hereunder, shall be due and payable in full upon the fortieth (40th)
anniversary of the Scheduled Series B Note Maturity Date (as defined below) (the “Maturity Date”); provided,
that the Maturity Date shall be automatically extended by one (1) calendar day for each calendar day after September 30, 2021
(the “Scheduled Series B Note Maturity Date”), if any, that all, or any part, of the Series B Note remains
outstanding.

 

2.
Payment of Interest. The unpaid Principal balance due hereunder shall bear interest (the “Interest”)
at an annual rate equal to 1.86% (the “Interest Rate”). Subject to Sections 3 and 7 below, Interest shall be
payable and due upon the Maturity Date. All interest shall be computed on the basis of a year of 365 or 366 days, as the case
may be, for the actual number of days (including the first day but excluding the last day) elapsed.

 

    	 	 	 

    	 

    

 

3.
Prepayment Prior to the Maturity Date.

 

(a)
Optional Prepayment. The Investor may, at its option at any time on or after the date hereof, prepay, in whole or in part,
without premium or penalty, the Obligations under this Note (each, an “Optional Prepayment”).

 

(b)
Mandatory Prepayment. Upon any Mandatory Prepayment Event (as defined below), the Investor shall promptly prepay such aggregate
outstanding Principal of this Note equal to the applicable Mandatory Prepayment Amount (as defined below) with respect to such
Mandatory Prepayment Event (each, a “Mandatory Prepayment”, and together with each Optional Prepayment, each
a “Prepayment”).

 

(c)
Mechanics of Prepayments. All Prepayments hereunder shall be made in cash, by wire transfer, in U.S. dollars and immediately
available funds, in accordance with the wire instructions delivered to the Investor by the Company on or prior to such date of
such Prepayment. At the option of the Company, prepayments may be made directly to the Company or to such other Persons as the
Company may direct in its wire instructions.

 

(d)
Cancellation of Interest upon Prepayment. Notwithstanding anything herein to the contrary, upon any Prepayment prior to
the Maturity Date (including, without limitation, any Mandatory Prepayment), the aggregate cash amount in such Prepayment shall
be applied entirely to and against any outstanding Principal under this Note, and any accrued and unpaid Interest with respect
to the Principal prepaid shall be automatically cancelled as of the date of such prepayment.

 

(e)
Definitions. For the purpose of this Note, the following definitions shall apply:

 

(i)
“Mandatory Prepayment Amount” means, as applicable, any Mandatory Prepayment Conversion Amount (as defined
below) or the Forced Mandatory Prepayment Amount (as defined below).

 

    	2

    	 

    

 

(ii)
“Mandatory Prepayment Event” means, as applicable, (i) with respect to any Restricted Principal of the Series
B Note designated to be converted in a Conversion Notice (such aggregate amount of Principal then outstanding hereunder equal
to such Restricted Principal of the Series B Note designated to be converted in such Conversion Notice, each, a “Mandatory
Prepayment Conversion Amount”), both (A) the Company’s receipt of such Conversion Notice thereunder executed by
the Investor in which all, or any part, of the principal of the Series B Note to be converted includes any Restricted Principal
and (B) the Investor’s receipt from the Company of written confirmation that the Company’s transfer agent (the “Transfer
Agent”) has been irrevocably instructed by the Company to deliver to the Investor (or its designee) the shares of Common
Stock to be issued pursuant to such Conversion Notice in accordance with Section 3(c) of the Series B Note (in each case, as adjusted,
if applicable, to reflect the withdrawal of any Conversion Notice, in whole or in part, by the Investor, whether pursuant to Section
3(c)(ii) of the Series B Note or otherwise), or (ii) with respect to any Principal outstanding hereunder on the Mandatory Prepayment
Date (as defined below) (the “Forced Mandatory Prepayment Amount”), the occurrence of the ninetieth Trading
Day after the Eligible Resale Date (the “Mandatory Prepayment Date”), so long as (u) the Company and its Subsidiaries
shall have received, in the aggregate, gross cash proceeds (in U.S. dollars and immediately available and unrestricted funds)
of at least $9,000,000 (less reasonable and documented fees and expenses of the Company’s legal counsel(s), financial advisor(s),
placement agent(s) and/or underwriter(s) (as applicable)) (the “Required Minimum Proceeds”) in respect of (A)
a sale of one or more portfolio assets for cash, (B) a Fundamental Transaction consummated by a Subsidiary, (C) one or more debt
or equity financings by a Subsidiary (by way of a private placement or other securities offering), or (D) a combination of the
foregoing, in each case, that does not constitute a Subsequent Placement or other issuance of securities by the Company (or securities
of a Subsidiary exercisable, convertible or exchangeable, as applicable, into securities of the Company); provided, that any debt
or other security issued in any such Fundamental Transaction, debt or equity offering or otherwise in connection therewith shall
not be subject to redemption or other repayment in cash while any Notes or 2018 Notes remain outstanding (the Company’s
receipt of such Required Minimum Proceeds in connection therewith without violating the conditions of this paragraph, the “Designated
Financing Condition”) on or prior to March 31, 2020, (w) the sum of (A) the aggregate principal of the Series A Note
and the 2018 Note (as defined in the Securities Purchase Agreement) outstanding as of the applicable Mandatory Prepayment Date
and (B) the aggregate Unrestricted Principal (as defined in the Series B Note) of the Series B Note that would be outstanding
after giving effect to such proposed Mandatory Prepayment on such Mandatory Prepayment Date, divided by (2) the Alternate Conversion
Price (as defined in the Series B Note) as of such Mandatory Prepayment Date, does not exceed 25% of the aggregate number of shares
of Common Stock of the Company issued and outstanding on each of the thirty Trading Days prior to and ending and including such
Mandatory Prepayment Date, (x) no Equity Conditions Failure (as defined in the Series A Note or Series B Note) exists as of such
Mandatory Prepayment Date, (y) as of the Mandatory Prepayment Date, both (I) the VWAP of the Common Stock on each Trading Day
during the five (5) Trading Day period ending on the Trading Day immediately preceding the Mandatory Prepayment Date and (II)
the VWAP of the Common Stock on at least sixteen (16) Trading Days during the twenty (20) Trading Day period ending on the Trading
Day immediately preceding the Mandatory Prepayment Date, as applicable, is greater than $0.8974 (as adjusted for stock
splits, stock dividends, stock combinations recapitalizations and similar events) (the failure of the Company to satisfy this
clause (y) as of the Mandatory Prepayment Date, if any, a “Minimum Price Failure”) and (z) no Event of Default
(as defined in the Series A or Series B Note) then exists and is continuing. Notwithstanding the foregoing, the Investor (or its
designee) shall not commence a Deposit/Withdrawal at Custodian with respect to such shares of Common Stock to be issued upon conversion
of Restricted Principal unless and until the Investor shall have either (x) delivered the Mandatory Prepayment Amount to the Company
or (y) delivered instructions to the Investor’s bank, broker or other financial institution to wire the Mandatory Prepayment
Amount to the Company from an account with at least an amount of cash or other Eligible Assets (as defined below) equal to the
Mandatory Prepayment Amount). “Eligible Resale Date” means the earlier of (x) the first date on which the resale
by the Buyers (as defined in the Securities Purchase Agreement) of all the Registrable Securities (as defined in the Registration
Rights Agreement) pursuant to one or more registration statements filed with the SEC has been declared effective by the SEC (and
each prospectus contained therein is available for use on such date) or (y) the first date on which all of the Registrable Securities
are eligible to be resold by the Buyers pursuant to Rule 144 (or, if a Current Public Information Failure (as defined in the Registration
Rights Agreement) has occurred and is continuing, such later date after which the Company has cured such Current Public Information
Failure).

 

    	3

    	 

    

 

4.
Defaults.

 

(a)
the Investor shall be deemed in default hereunder upon the occurrence of any of the following (a “Default”):

 

(i)
Failure to Pay Principal or Interest. The failure of the Investor to pay, when due, all or any part of any Principal or
Interest required to be made hereunder; or

 

(ii)
Bankruptcy, etc. The Investor shall have entered against it by a court having jurisdiction thereof a decree or order for
relief in respect to the Investor in an involuntary case under any applicable bankruptcy, insolvency or other similar law now
or hereafter in effect, or a receiver, liquidator, assignee, custodian, trustee, sequestrator or other similar official shall
be appointed for the Investor or for any substantial part of the Investor’s property, or the winding up or liquidation of
the Investor’s affairs shall have been ordered; or the Investor shall commence a voluntary case under any applicable bankruptcy,
insolvency or other similar law now or hereafter in effect; or the Investor shall consent to the entry of an order for such relief
in an involuntary case under any such law, or any such involuntary case shall commence, and not be dismissed within sixty (60)
days; or the Investor shall consent to the appointment of or taking possession by a receiver, liquidator, assignee, custodian,
trustee, sequestrator or other similar official for the Investor or for any substantial part of the Investor’s property,
or make any general assignment for the benefit of creditors.

 

    	4

    	 

    

 

(b)
Consequence of Default. Upon the occurrence of a Default, the outstanding Obligations hereunder shall, at the option of
the Company, become immediately due and payable (each, an “Investor Note Acceleration”), subject to the Investor’s
right to elect to effect Default Netting (as defined below) with respect to all, or any portion, of this Note as elected by the
Investor in a written notice to the Company. Notwithstanding the foregoing, if there shall occur a Default under Section 4(a)(ii)
above, the entire outstanding Obligations hereunder, shall automatically become immediately due and payable without any action
on the part of the Company and the Investor shall be deemed to have elected Default Netting with respect to the maximum amount
of its obligations outstanding hereunder as permitted pursuant to Section 7(h) below. Upon the occurrence of a Default, the Company
shall also have all the rights and remedies of a secured party on default under Article 9 of the Uniform Commercial Code of the
State of New York with respect to the Collateral (as hereinafter defined).

 

5.
Representations and Warranties of the Investor. The Investor represents and warrants to the Company as follows as of the
date hereof: (a) the Investor has the power and authority to execute, deliver and perform all obligations in accordance herewith;
(b) the execution, delivery and performance by the Investor of this Note are within the Investor’s legal powers, and do
not contravene any law or any contractual restriction binding on or affecting the Investor; (c) no authorization or approval or
other action by, and no notice to or filing with, any governmental authority or regulatory body is required for the due execution,
delivery and performance by the Investor of this Note; (d) this Note constitutes the legal, valid and binding obligation of the
Investor, enforceable against the Investor in accordance with its terms, except to the extent enforceability is limited by bankruptcy,
insolvency, fraudulent conveyance, moratorium and other laws for the protection of creditors generally and by general equitable
principles; and (e) there is no pending or, to the Investor’s knowledge, threatened action or proceeding affecting the Investor
before any governmental agency or arbitrator with respect to the transactions contemplated by this Note or which may materially
adversely affect the property, assets or condition (financial or otherwise) of the Investor.

 

6.
Security.

 

(a)
Grant of Security Interest. As security for the due and prompt payment and performance of all payment obligations under
this Note and any modifications, replacements and extensions hereof (collectively, “Secured Obligations”),
the Investor hereby pledges and grants a security interest to the Company in all of the Investor’s right, title, and interest
in and to, initially at least $3,150,000, in the aggregate, (i) in cash, (ii) cash equivalents (including but not limited to term
deposit accounts), (iii) any Group of Ten (“G10”) currency and any notes or other securities issued by any
G10 country and (iv) any securities of a special purpose acquisition company (each, a “SPAC”) that are redeemable
for cash held in escrow by such SPAC (with a deemed fair market value, for purposes hereof, equal to the amount of cash held in
such escrow for redemption of such applicable security of such SPAC) (collectively, the “Eligible Assets”),
in each case, held by the Investor in the bank or brokerage accounts described on Schedule I attached hereto (the “Collateral”,
and such account or accounts, as applicable, collectively, the “Collateral Account”), subject to reduction
upon any reduction, offset or cancellation of this Note. So long as any Restricted Principal (as defined in the Series B Note)
remains outstanding under the Series B Note, the Investor shall keep Collateral in the Collateral Account with a fair market value
of at least the amount of Restricted Principal then outstanding, and shall not grant a security interest in the Collateral to
secure any other obligations of the Investor or any other Person (as defined in the Series B Note).

 

    	5

    	 

    

 

(b)
Change in Collateral Account. The Investor may, with at least five (5) Trading Days’ notice to the Company, move
the Collateral from an account or accounts of the Investor to a new account or accounts (the “New Collateral Account”)
at a financial institution selected by the Investor, (but if such financial institution is not listed as a permitted financial
institution on Schedule II attached hereto, subject to the consent of the Company, not to be unreasonably withheld), and upon
such move, such New Collateral Account shall be the Collateral Account for all purposes hereunder.

 

7.
Netting Rights.

 

(a)
Securities Contract. The Company and the Investor hereby acknowledge and agree that the Securities Purchase Agreement and
the Note Purchase Agreement each is a “securities contract” as defined in 11 U.S.C. § 741 and that Investor shall
have all rights in respect of the Investor Note, the Series B Note, the Master Netting Agreement, the Securities Purchase Agreement
and the Note Purchase Agreement as are set forth in 11 U.S.C. § 555 and 11 U.S.C. § 362(b)(6), including, without limitation,
all rights of credit, deduction, setoff, offset, recoupment, and netting (collectively, “Netting” or “Net”)
as are available under this Note, the Series B Note and the Master Netting Agreement.

 

(b)
Investor Optional Netting. Notwithstanding anything herein to the contrary, the Investor may, (I) on or after the May 31,
2020 (such date, the “Eligible Optional Netting Date”) or (II) at any time on or after the occurrence of a
Minimum Price Failure as of the Mandatory Prepayment Date, an Event of Default (as defined in the Series B Note) or a Change of
Control (as defined in the Series B Note) (or the announcement of such Change of Control) (in each case, whether or not a Redemption
Notice (as defined in the Series B Note) has been delivered by the Investor to the Company with respect thereto) (each, an “Investor
Optional Netting Election Notice”), Net, in whole or in part, any Permitted Amount (as defined in the Master Netting
Agreement) of any Unpaid Amount (as defined in the Master Netting Agreement) owed by the Investor to the Company under this Note
or any other Underlying Agreement (as defined in the Master Netting Agreement) against (across or within each or all of the Underlying
Agreements) (x) any Unpaid Amounts owed by the Company to the Investor under the Series B Notes or (y) any Unpaid Amounts (subject
to the limitations contained in the Master Netting Agreement regarding an Equity Conditions Failure) owed by the Company to the
Investor under any other Underlying Agreement, as set forth in such written notice (each, an “Investor Optional Netting”);
provided, that no Investor Optional Netting shall occur hereunder with respect to any Mandatory Prepayment Amount that the Investor
fails to properly prepay hereunder in violation of this Note. Each Investor Optional Netting shall occur on such applicable date
as set forth by the Investor in the Investor Optional Netting Election Notice. Upon any Investor Optional Netting, (x) such portion
of Principal subject to such Investor Optional Netting shall be deemed surrendered and concurrently cancelled as of the date of
such Investor Optional Netting and (y) any accrued and unpaid Interest hereunder with respect to such portion of Principal subject
to such Investor Optional Netting shall be automatically cancelled as of the date of such Investor Optional Netting. Each Investor
Optional Netting shall be effective upon the date the Investor delivers written notice to the Company of the Investor’s
election to effect such Investor Optional Netting. In no event shall the Investor have the right to elect to effect any Investor
Optional Netting with respect to any Mandatory Prepayment Amount that is due and payable.

 

    	6

    	 

    

 

(c)
Netting at Redemption Date. Notwithstanding anything herein to the contrary, with respect to any required redemption of
all, or any part, of the Series B Note, solely to the extent such portion of the Conversion Amount (as defined in the Series B
Note) subject to such redemption includes Restricted Principal (such aggregate amount of Restricted Principal, each, a “Redemption
Restricted Amount”), the Investor, at its sole discretion, by written notice (each, a “Redemption Netting Election
Notice”) to the Company, may Net (each, a “Redemption Netting”) such part of the outstanding obligations
under the Series B Note equal to such Redemption Restricted Amount by the cancellation of the Redemption Restricted Amount of
the outstanding obligations under the Series B Note in exchange for the surrender and concurrent cancellation of such portion
of this Note with an amount of aggregate Principal then outstanding hereunder equal to such Redemption Restricted Amount (each
a “Redemption Netting Principal Amount”). Upon any Redemption Netting, any accrued and unpaid Interest hereunder
with respect to such Redemption Netting Principal Amount being cancelled in such Redemption Netting shall be automatically cancelled
as of the date of such Redemption Netting and, thereafter, such Redemption Netting Principal Amount of this Note shall be deemed
to be paid in full and shall be null and void. Each Redemption Netting shall occur on such applicable date as set forth by the
Investor in the Redemption Netting Election Notice. For the avoidance of doubt, if prior to the date of the applicable Redemption
Netting all, or any portion, of a Redemption Restricted Amount is converted (whether by Acceleration (as defined in the Series
B Note) or otherwise in accordance with the terms of the Series B Note) or, with respect to an Installment Amount, subject to
a Deferral (as defined in the Series B Note) or a waiver of an Equity Conditions Failure or such other event occurs whereafter
such portion of the Redemption Restricted Amount is not required to be redeemed on the Redemption Date in accordance with the
terms of the Series B Note (as amended, modified or waived on or prior to such date)(each a “Reversed Redemption Restricted
Amount”), solely with respect to such Redemption Date, no Redemption Netting shall occur with respect to such Reversed
Redemption Restricted Amount.

 

(d)
Automatic Netting at Maturity. Notwithstanding anything herein to the contrary, at the Maturity Date (as defined in the
Series B Note), if any amounts remain outstanding under the Series B Note and hereunder, the Investor shall automatically Net
such part of the outstanding obligations under the Series B Note equal to the aggregate Principal then outstanding hereunder (the
“Remaining Principal Amount”) by the cancellation of the Remaining Principal Amount of the outstanding obligations
under the Series B Note in exchange for the surrender and concurrent cancellation of the aggregate Principal then outstanding
hereunder (the “Maturity Netting”). Upon any Maturity Netting, any accrued and unpaid Interest hereunder with
respect to such portion of Principal being cancelled in such Maturity Netting shall be automatically cancelled as of the date
of such Maturity Netting and, thereafter, this Note shall be deemed to be paid in full and shall be null and void. The Maturity
Netting shall automatically occur on the Maturity Date (as defined in the Series B Note).

 

    	7

    	 

    

 

(e)
Event of Default Netting. Notwithstanding anything herein to the contrary, Investor may, at any time on or after the occurrence
of any Event of Default under the Series B Note, but prior to the related Event of Default Right Expiration Date (as defined in
the Series B Note, at its sole discretion, by written notice to the Company, Net all, or any part, of the outstanding obligations
under the Series B Note by the cancellation of such portion of the outstanding obligations under the Series B Note as set forth
in such written notice in exchange for the surrender and concurrent cancellation of an equal amount of Principal hereunder (each,
an “Event of Default Netting”). Upon any Event of Default Netting, any accrued and unpaid Interest hereunder
with respect to such portion of Principal being satisfied in such Event of Default Netting shall be automatically cancelled as
of the date of such Event of Default Netting. Each Event of Default Netting shall be effective upon the date the Investor delivers
notice to the Company of the Investor’s election to effect such Event of Default Netting.

 

(f)
Automatic Netting Upon any Bankruptcy Event of Default. Notwithstanding anything herein to the contrary, upon any Bankruptcy
Event of Default under the Series B Note, the Investor shall automatically Net such part of the outstanding obligations under
the Series B Note equal to the Remaining Principal Amount by the cancellation of the Remaining Principal Amount of the outstanding
obligations under the Series B Note in exchange for the surrender and concurrent cancellation of the aggregate Principal then
outstanding hereunder (each, a “Bankruptcy Event of Default Netting”, and together with the Investor Optional
Netting, Redemption Netting, Maturity Netting, Event of Default Netting and Default Netting (as defined below), collectively,
the “Investor Netting Rights”). Upon any Bankruptcy Event of Default Netting, any accrued and unpaid Interest
hereunder with respect to such portion of Principal being satisfied in such Bankruptcy Event of Default Netting shall be automatically
cancelled as of the date of such Bankruptcy Event of Default Netting and, thereafter, this Note shall be deemed to be paid in
full and shall be null and void. Each Bankruptcy Event of Default Netting shall be effective upon the date of the earliest occurrence
of a Bankruptcy Event (as defined in the Series B Note) under the Series B Note.

 

(g)
Automatic Netting Upon Prohibited Transfers of this Note. If for any reason, this Note or any interest herein is pledged,
assigned or transferred to any Person other than the Company without the prior written consent of the Investor, whether by contract,
operation of law, court order or otherwise (each, a “Prohibited Transfer”), the Investor shall automatically
Net such part of the outstanding obligations under the Series B Note equal to 75% of the remaining Restricted Principal then outstanding
under the Series B Note (with the remaining 25% of the Restricted Principal of the Series B Note automatically becoming unrestricted
principal thereunder) in exchange for the surrender and concurrent cancellation of the aggregate Principal then outstanding hereunder.
Upon any Prohibited Transfer, any accrued and unpaid Interest hereunder shall be automatically cancelled as of the date of such
Prohibited Transfer and, thereafter, this Note shall be deemed to be paid in full and shall be null and void.

 

    	8

    	 

    

 

(h)
Default Netting. Notwithstanding anything herein to the contrary, Investor may, at any time on or after the occurrence
of any Investor Note Acceleration, by written notice to the Company (each, a “Default Netting Electing Notice”),
in lieu of making any payment under this Note in cash, Net all, or any part, of the outstanding obligations under the Series B
Note by the cancellation of such portion of the outstanding obligations under the Series B Note as set forth in such written notice
in exchange for the surrender and concurrent cancellation of an equal amount of Principal hereunder (each, a “Default
Netting”). Each Default Netting shall occur on such applicable date as set forth by the Investor in the Default Netting
Election Notice. Upon any Default Netting, any accrued and unpaid Interest hereunder with respect to such portion of Principal
being satisfied in such Default Netting shall be automatically cancelled as of the date of such Default Netting. Each Default
Netting shall be effective upon the date the Investor delivers notice to the Company of the Investor’s election to effect
such Netting. Except as provided in the second sentence of Section 4(b) above, in no event shall the Investor have the right to
elect to effect any Default Netting with respect to any Mandatory Prepayment Amount that is due and payable.

 

(i)
Investor Netting Rights; Single Integrated Transaction. The Company hereby acknowledges and agrees that (i) the Investor
shall be entitled to exercise the Investor Netting Rights through any means permissible under applicable law, including without
limitation, set-off and Netting and (ii) the Obligations of the Investor hereunder and the obligations of the Company under the
Series B Note issued pursuant to the Securities Purchase Agreement arise in a single integrated transaction and constitute related
and interdependent obligations within such transaction.

 

8.
Miscellaneous.

 

(a)
Full Recourse. The parties hereby acknowledge and agree that this Note is a full recourse obligation of the Investor.

 

(b)
No Oral Waivers or Modifications. No provision of this Note may be waived or modified orally, but only in a writing signed
by the Company and the Investor.

 

(c)
Governing Law. This Note shall be construed and enforced in accordance with, and all questions concerning the construction,
validity, interpretation and performance of this Note shall be governed by, the internal laws of the State of New York, without
giving effect to any choice of law or conflict of law provision or rule (whether of the State of New York or any other jurisdictions)
that would cause the application of the laws of any jurisdictions other than the State of New York. Each party hereto hereby irrevocably
submits to the exclusive jurisdiction of the state and federal courts sitting in the Borough of Manhattan in the City of New York,
New York, for the adjudication of any dispute hereunder or in connection herewith or with any transaction contemplated hereby
or discussed herein, and hereby irrevocably waives, and agrees not to assert in any suit, action or proceeding, any claim that
it is not personally subject to the jurisdiction of any such court, that such suit, action or proceeding is brought in an inconvenient
forum or that the venue of such suit, action or proceeding is improper. Nothing contained herein shall be deemed to limit in any
way any right to serve process in any manner permitted by law. EACH PARTY HERETO HEREBY IRREVOCABLY WAIVES ANY RIGHT IT MAY HAVE
TO, AND AGREES NOT TO REQUEST, A JURY TRIAL FOR THE ADJUDICATION OF ANY DISPUTE HEREUNDER OR IN CONNECTION WITH OR ARISING OUT
OF THIS NOTE OR ANY TRANSACTION CONTEMPLATED HEREBY.

 

    	9

    	 

    

 

(d)
No Severability. If any provision of this Note is prohibited by law or otherwise determined to be invalid or unenforceable
by a court of competent jurisdiction or other similar authority (a “Severability Event”), this entire Note
shall be automatically terminated and shall thereafter be null and void and all remaining payment obligations hereunder of the
Investor to the Company shall be automatically cancelled, ab initio.

 

(e)
Currency. Principal and interest due hereunder shall be payable in lawful money of the United States of America and shall
be payable to the Company at the address of the Company, or at such other address as may be specified in a written notice to the
Investor given by the Company. The Company has provided the Investor with wire transfer instructions pursuant to which payments
may be made under this Note and such wire transfer instruction shall be valid for the entire period of this Note.

 

(f)
Weekend; Holidays.If any payment on this Note shall become due on a Saturday, Sunday or a bank or legal holiday in
the State of New York, such payment shall be made on the next succeeding business day in the State of New York.

 

(g)
Usury. If interest payable under this Note is in excess of the maximum permitted by law, the interest chargeable hereunder
shall be reduced to the maximum amount permitted by law and any excess over the maximum amount permitted by law shall be credited
to the Principal balance of this Note and applied to the same and not to the payment of Interest.

 

(h)
Remedies.

 

(i)
No failure on the part of the Company to exercise, and no delay in exercising, any right, power or remedy hereunder shall operate
as a waiver thereof; nor shall any single or partial exercise by the Company of any right, power or remedy preclude any other
or further exercise thereof or the exercise of any other right, power or remedy. In addition, the exercise of any right or remedy
of the Company at law or equity or under this Note shall not be deemed to be an election of Company’s rights or remedies
under this Note or at law or equity.

 

(ii)
No failure on the part of the Investor to exercise, and no delay in exercising, any right, power or remedy hereunder (including,
without limitation, any Netting permitted hereunder) shall operate as a waiver thereof; nor shall any single or partial exercise
by the Investor of any right, power or remedy preclude any other or further exercise thereof or the exercise of any other right,
power or remedy. The remedies herein provided are cumulative and are not exclusive of any remedies provided by law. In addition,
the exercise of any right or remedy of the Investor at law or equity or under this Note shall not be deemed to be an election
of Investor’s rights or remedies under this Note or at law or equity.

 

(i)
Waiver of Presentment. The Investor hereby waives presentment, diligence, protest and demand, notice of protest, demand
and dishonor and nonpayment of this Note.

 

[Signature
Page Follows]

 

    	10

    	 

    

 

IN
WITNESS WHEREOF, this Note has been executed as of the date first written above.

 

	 	 	 	Alto
    Opportunity Master Fund, SPC - Segregated Master Portfolio B
	 	 	 	 	 
	 	 	 	By:	                 
	 	 	 	Name:	 
	 	 	      	Title:	 
	 	 	 	 	 
	Agreed
        and accepted as of

        this
        4th day of November, 2019 by:
	 	 	 
	 	 	 	 	 
	PAVMED
    INC.	 	 	 
	 	 	 	 	 
	By:	      	 	 	 
	Name:	 	 	 	 
	Title:	 	 	 	 

 

    	 	 	 

    	 

    

 

IN
WITNESS WHEREOF, this Note has been executed as of the date first written above.

 

	 	 	 	Alto
    Opportunity Master Fund, SPC - Segregated Master Portfolio C
	 	 	 	 	 
	 	 	      	By:	                 
	 	 	 	Name:	 
	 	 	 	Title:	 
	 	 	 	 	 
	Agreed
        and accepted as of this 4th day of

        November,
        2019 by:
	 	 	 
	 	 	 	 
	PAVMED
    INC.	 	 	 
	 	 	 	 	 
	By:	 	 	 	 
	Name:	       	 	 	 
	Title:

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