Upozornění: Text přílohy byl získán strojově a nemusí přesně odpovídat originálu. Zejména u strojově nečitelných smluv, kde jsme použili OCR. originál smlouvy stáhnete odsud
MERCK
Merck spol. s r.o.
SMLOUVA o DAROVANi NA PODPORU ZDRAVOTNi péée /
HEALTHCARE-RELATED DONATION REQUEST FORM AND AGREEMENT
Tato Smlouva o darovani ve prospéch pacienta This Agreement for Donation for Patient Benefit
(”Srnlouva“) je uzavFena mezi Merck spol. s (“Agreement”) is between Merck spol. s r.o., Na
r.o., Na hrebenech 11 1718/10, 14000 Prague, hfebenech II 1718/10, 14000 Prague,
(dale jen ,,Spoleénost“), a (hereinafter referred to as “Company”), and
Nézev iédajici organizace (“iadatel”) Krajska 2dravotni a.s.
25488627
/ Name of Requesting Organization (“Requester”):
Iéo / ID:
Adresa sidla iadatele / Street Address: Socialni péce 3316/12A
Usti nad Labem, 401 13
Mésto, Psi: / City, Zip: Czech Republic
Stét/ Country:
Telefonni éislo / Telephone Number:
Email:
Interni éislo / Company’s Unique Identifier for 01 1044783 1
Requester:
Kontaktni osoba ve SpoleEnosti
/ Company Contact Person:
Spoleéné oznacené jako ,,Strany," kaida’ zvla’st' pak jako ,,Strana“. / Together referred to as the “Parties", and
individually referred to as a “Party".
Merck spol. s r. 0. 10f7
Verze 3-5/2018
Na Hrebenech 11 1718/10
140 00 Praha 4 Ceské Republika
1. Pozadi 1. Background
Zadatel podal spolecnosti Merck za’dost o darova’ni Requestor has submitted an application to receive a
Donation for Patient Benefit from the Merck
ve prospéch pacienta (Ph’loha A této Smlouvy) Organization (attached hereto in Exhibit A) (the
("Formulaf za'dosti o darovani ve prospéch
“Donation for Patient Benefit Request Form”). The
pacienta”). Spolecnost Merck schvalila zadost Merck Organization has approved Requestor’s
Zadatele o darova’ni’ ve prospéch pacienta za application for the Donation for Patient Benefit under
podmi’nek stanovenych touto Smlouvou. the terms and conditions set forth in this Agreement.
2. Definice 2. Definitions
2-1 Wm Prévni pfedpisy, 2.1 Applicable Laws. The laws, rules,
pravidla, nai‘izeni a vyhlasky upravuji'ci cinnost dle regulations and ordinances governing the activity
této Smlouvy.
contemplated by this Agreement.
2.2 Darova’ni/dar ve prospéch pacienta. 2.2 Donation for Patient Benefit. The provision
Poskytnuti financni nebo jine' podpory ve formé of financial or other support in the form of money,
penéz, sluieb, zbozi nebo jinych hodnot v podobé services, goods, or other items of value in the form
Darova’ni ve prospéch pacienta nebo Darovani a Donation for Patient Benefit or a Product Donation.
produktu.
2.3 Zdravotnicky’ odbornik. Kazdy skoleny 2.3 Healthcare Professional. Any trained
odbornik, ktery je opravneny v souladu professional who is licensed to, or any other person
sPrislusnymi pfedpisy, nebo jina osoba, které who in the course of his/her professional activities
vra'mci predmétu své profesni cinnosti smi, may, prescribe, recommend, purchase, dispense,
predepisovat, doporucovat, nakupovat, vydavat supply, or administer Pharmaceutical Products or
nebo podavat farmaceutické vyrobky nebo provide healthcare services and his/her office staff,
poskytovat zdravotni’ sluzby a personal takové and any payor for Pharmaceutical Products, including
osoby, a da‘le platce za farmaceutické vyrobky, any national and local reimbursement authority.
vcetné na’rodni'ch a mistni’ch autorit, které jsou
odpovédné za poskytovani’ L'ihrady zveFejného
zdravotniho pojisténi.
2.4 Farmaceuticky’ vy’robek. Jakykoliv lék/lécivy 2.4 Pharmaceutical Product. Any the Merck
pfipravek, biologicky produkt nebo zdravotnicky Organization '5 drug/medicinal product, biological
prostfedek spolecnosti Merck (bez ohledu na to, product, or medical device (irrespective of patent
jestli pozi’va patentovou ochranu a/nebo ochrannou status and/or whether it is branded or not), whether
znamkou nebo ne), ktery se pouiiva samostatné used alone or in combination, whether is or is not
nebo v kombinaci, at'jiz neni' nebo je urcen k pouziti’ intended to be used on the prescription of, or under
na predpis nebo na poukaz nebo pod dohledem the superwsion of, a Healthcare Professional, and
Zdravotnického odborni’ka a ktery se pouzi’va’ pfi which is intended for use in the diagnosis, treatment,
diagnostikovani, |éébé nebo prevenci nebo ktery or prevention of disease in humans, or to affect the
jinak pfisobi na strukturu nebo funkci lidského téla. structure or any function of the human body.
3. Vyhla'seni, zévazky a povinnosti
3. Representations, Warranties, and
Spolecnost Merck poskytne predmétné darovani Obligations
pouze 2a podminky, 2e darovani bude pouzito
v souladu s ph’kazem specifikovanym niie. Zadatel The Merck Organization shall provide this Donation
only if the Merck Organization’s instruction, specified
timto prohlasuje, zavazuje se a sjedna’va nasleduji’ci: below, will be complied with. Requestor hereby
represents, warrants, and covenants as follows:
(i) Je plné zpfisobily a opra’vnény
uzavri't tuto Smlouvu; (i) It has the full power and right to
enter into this Agreement.
(ii) Vra'mci zadosti o darovani ve
prospéch pacienta jednal (ii) It has complied with all Applicable
vsouladu se vsemi pFislusnymi Laws in its application for a
predpisy a nadale bude jednat Donation for Patient Benefit from
v souladu s prislusnymi predpisy the Merck Organization and will
pri Cinnostech, které souvisi comply with all Applicable Laws in
s jakymkoliv darova’ni’m ve undertaking activities in
prospéch pacienta podle této connection with any Donation for
Smlouvy; Patient Benefit from the Merck
Organization under this
(iii) Nepredstavuje iadny Agreement;
z na'sledujicich subjektfi: (a)
jednotlivec, vcetné jednotlivého (iii) It is not any of the following: (a)
Zdravotnického odborni'ka (b) an individual, including an
na'boienska organizace, ktera individual Healthcare Professional,
(b) a religious organization
iada o darovani ve prospech seeking the Donation for Patient
Benefit for sectarian religious
pacienta pro sektarské purposes, or (c) an academic
naboienské UCely, nebo (c) institution's alumni association;
sdruieni absolventfi akademické
instituce;
(W) Nejedna' diskriminacné na zakladé (W) It does not discriminate by age,
(V) véku, rasy, pohlavi, naboienstvi, race, sex, religion, sexual
(Vi) sexualni orientace nebo orientation, or disability;
(vii) zdravotni'ho nebo menta’lniho
(viii)
postiieni;
(viii)
(ix) Zadatel se zavazuje pouiit (V) It shall use the Donation in
predmétné darovani vsouladu accordance with the Merck
spfikazem spolecnosti Merck. Organization's instruction. The
Prikaz spoleénosti Merck Merck Organization's instruction
stanovuje, 2e: (1) darovanl' ve stipulates that it shall: (1) use the
prospéch pacienta musi byt Donation for Patient Benefit only
pouiito vyIUCné na ucely for the purposes specified under
specifikované vtéto Smlouvé a this Agreement, as described in
detailné popsané ve formula’ri detail in the Donation for Patient
ia’dosti o darova’ni ve prospéch Benefit Request Form, (2) never
pacienta, (2) darovani’ use the Donation for Patient
ve prospéch pacienta se nesmi Benefit for the personal use or
pouéit pro vlastni' osobni prospéch benefit of its employees and/or
Zadatele nebo pro osobni' their family members, and (3) in
prospéch jeho zaméstnancfi
case of any program/event under
a/nebo jejich rodinnych this Agreement with attendance of
pfisluénikfi, a (3) v pfipadé Healthcare Professionals, this
jakéhokoli programu/akce podle support shall be used with respect
této Smlouvy, na kterych se maji to all relevant regulation
ucastnit Zdravotnicti odbornici, concerning provision of any
musi byt podpora takove’ho fulfillments to the Healthcare
programu/akce pouiita s ohledem Professionals, especially with
na prislusné pravni’ pFedpisy relevant ethical regulation and Act
tykajici se poskytova’ni plnéni’ No. 40/1995 Coll., on Advertising
Zdravotnickym odbornikfim, a to Regulation, as amended, and (4)
zejména s ohledem na prislusnou never use the Healthcare—related
etickou regulaci a zékon 6. Donation for commercial purpose
40/1995 5b., 0 regulaci reklamy, when Pharmaceutical Products are
ve znéni pozdéjsich predpisfi, and donated;
(4) v pripadé, 2e jsou ptedmétem
darova’ni’ Farmaceutické vyrobky,
tyto nesmi byt nikdy pouiity pro
komercni ucely;
Zadatel se timto zavazuje (Vi) Requestor hereby undertakes to
prove such use of the Donation in
proka’zat pouiiti predmétného (vii) accordance with article 3 point (ix)
darovéni’ vsouladu séla’nkem 3 of this Agreement;
bod (ix) této Smlouvy; (viii)
(viii) The Donation for Patient Benefit is
Ucelem darova’ni ve prospéch
(iX) intended to benefit patients rather
pacienta je poskytnout prospech
than the institutions,
pacientfim, nikoli institucim,
organizations, or associations that
organizacim nebo sdruienim,
které dar pfimo prijmou; directly receive the support;
2adate| mfiie vydétovat pacientfim It shall only charge patients on the
incidental costs incurred by it in
pouze vedlejsi naklady, které mu providing the Healthcare-related
vznikly pFi poskytnuti darovani ve Donation;
prospéch pacienta.
Zadatei jasné a zretelné prizné It shall clearly and prominently
acknowledge such Donation for
poskytnuti darovani ve prospéch Patient Benefit in any publication,
pacienta vjakékoli publikaci, v
materia’lu nebo vra’mci cinnosti material, or activity resulting from
vyplyvajici z poskytnuté podpory; the support;
iadatel bude udriovat zaznamy It shall maintain records relating
ve vztahu to funds received as a result of the
k prostredkfim
obdrienym jako darovani ve
prospéch pacienta a ve vztahu Donation for Patient Benefit and
related expenditures and uses for
k souvisejicim vydajfim a pouiitim one (1) year from the Effective
Date hereof. Requestor shall prove
p0 dobu Jednoho roku ode dne the use of the Donation in
accordance with this Agreement
L'iéinnosti této Smlouvy. Zadatel (especially with the Merck
prokaie pouiiti darovani v souladu Organization’s instruction as
stouto Smlouvou (pfedevsim stated in article 3 point (v) above)
v souladu s pfikazem spoiecnosti anytime within this period upon
Merck, jak je tento uveden request of the Merck Organization
v (:lénku 3 bod (v) vyse) kdykoliv or any of the Merck Organization’s
vra'mci této doby na ia’dost affiliates. The Merck Organization
spolecnosti Merck nebo kterékoli or any of Merck’s affiliates shall
have the right, upon reasonable
ze spoleénosti koncernu Merck notice, to examine such records;
Group (dale také jen "Pfidruiené
osoby“). Spolecnost Merck nebo
Pfidruiené osoby maji’ pra‘vo po
pfedchozim ozna’meni' tyto
za’znamy pfezkoumat;
(x) Zadatel bezodkladné doruci (x) It shall promptly deliver to the
spolecnosti Merck vsechny Merck Organization any additional
doplr'iujici informace odfivodnéné information reasonably requested
poiadované jako podpora to support Requestor’s application
Zadatelovy iadosti o darova’ni ve for a Donation for Patient Benefit,
prospéch pacienta, mimo jiné take including, without limitation, any
konferencni nebo programové conference or other program or
nebo jiné materiély; exhibit materials;
(xi) Darovani ve prospéch pacienta (xi) This Donation for Patient Benefit is
neni pfijato jako odména nebo not being received as a reward or
protisluiba za doporuéeni, in exchange for recommending,
pfedepsa’ni, vydavani, prescribing, dispensing,
nakupovani, dodavani, prodej, purchasing, supplying, selling,
podava'ni, posilani, dojednani nebo administering, referring, arranging
objednévani Farmaceutickych for, or ordering Pharmaceutical
vyrobkfi, nebo pobidka k Products, or to induce Requestor
doporuceni, pfedepsani’, vydavani’, recommending, prescribing,
nakupovéni, doda’va’ni, prodeji, dispensing, purchasing, supplying,
poda'vani, posila'ni', dojednani nebo selling, administering, referring,
objednévéni Farmaceutickych arranging for, or ordering
vyrobkfi v budoucnosti; Pharmaceutical Products in the
(xii) 2adatel neuskutecni iadnou future; and
platbu ani nepfevede iadnou (xii) Requestor shall make no payment
hodnotu, pfi’mo ani nepfimo, na
nor transfer anything of value,
ia’dne’ho Ofednika nebo jinou
directly or indirectly, to any official
osobu, za ucelem ovlivnéni’
or other person to influence any
rozhodnuti takové osoby k ziska’ni’
decision to obtain or retain
nebo zachovéni podnikani nebo
ziskani vyhody v podnikani nebo business or gain an advantage in
pobi’dky Ufedni’ka nebo jiné osoby
uskutecnit cinnost vrozporu the conduct of business, or to
s pfislusnymi pfedpisy.
induce such official or other person
to perform a function in violation
of any Applicable Laws.
4. Zvei‘ejnéni plateb 4. Payments Disclosure
Zadatel souhlasi s tim, ie spoleénost Merck a/nebo Requestor consents that Merck and/or its affiliated
companies may publicly disclose payments and
jeji pfidruiené spoleénosti mohou gvefejnit platby a transfers of value to Requestor and its affiliated
pfevody hodnot ve prospéch Zadatele a jeho companies. Disclosure may consist of aggregate
pridruienych spolecnostl'. ZveFejnéni se mfiie payments, dates and purposes (without disclosing
names of Requestor) or specific payments, dates and
skladat ze souhrnu plateb, clat a L'icelfi (bez
purposes, and names of Requestor and affiliated
zvefejnéni jmen Zadatele) nebo z konkrétnich companies. Where required by mandatory laws,
plateb, dat a L'iéelfi, a jmen Zadatele a pfidruienych Requestor will provide consent in a separate form
osob. Pokud je to povinné vyiadovano pravnimi provided by Merck
pfedpisy, Zadatel poskytne souhlas prostfednictvim
oddéleného formulate poskytnutého spoieénosti
Merck.
5. Ochrana osobnich fldajfi 5. Data Protection
5.1 Osobni udaie personalu Zadatele. 5.1 Requestor's Personnel Personal Data. In
V souvislosti s touto Smlouvou mfiie byt spoleénost connection with this Agreement, Merck may be called
Merck vyzvana, aby poskytla osobni' Lidaje upon to provide personal data of Healthcare
zdravotnickych odbornikfi poskytujicich sluiby Professionals providing services on behalf of
jménem Zadatele a také daisich zaméstnancfi a
zastupcfi Zadatele (spoleéné ,,Persona’l“). Udaje Requestor and other Requestor's employees and
spadaji’ do pfisobnosti pravni'ch predpisfi tykajicich se representatives (together “Personnel"). The data
ochrany ,,osobnich Udajfi“, jak jsou tyto definovany falls within the scope of the law and regulations
vpravnich pfedpisech o ochrane osobni'ch Udajfi relating to the protection of “personal data” as
platnych pro spolecnost Merck (“PFi’slusné pravni defined in data protection laws applicable to Merck
pfedpisy o ochrané osobnich udajfi ”). (“Applicable Data Protection Laws”).
5.2 Kateciorie osobnich L'Jdaifi a 06e 5.2 Categories of Personal Data and Purposes of
zpracovani’. Tyto osobhi Lidaje mohou zahrnovat Processing. This personal data may include names,
jména, kontaktni informace, pracovni zkusenosti a
contact information, work experience and
odbornou kvalifikaci, publikace, interakce mezi
spoieénosti Merck a Zadatelem na zakladé této professional qualifications, publications, interactions
Smlouvy (“Osobni' Udaje”). Spoleénost Merck
zpracovava takové Osobni i’idaje pro splnéni' této between Merck and Requestor under this Agreement
Smlouvy.
(“Personal Data”). Merck processes such Personal
Data for the performance of this Agreement.
5.3 Sdi’leni Lidajfi, Spolecnost Merck mfiie sdilet 5.3 Data Sharing. Merck may share Personal
Osobni ddaje (i) se svymi poskytovateii sluieb, kteri Data (i) with its service providers that process
zpracovavaji’ Osobni Udaje jeji'm jménem a v souladu Personal Data on its behalf and according to its
s jejimi pokyny a (ii) 5 ostatnimi pfidruienymi instructions and (ii) with other affiliated companies
spolecnostmi pro urcené ucely stanovené v ust. 5.2. for the purposes set forth in Section 5.2. Recipients
Pfijemci Osobni'ch Udajfi podle tohoto ust. 5.3 mohou of Personal Data according to this Section 5.3 may
byt rovnéi usazeni v zemich mimo EU nebo Evropsky also be established in countries outside the EU or the
hospodaky prostor (“EHS”). Pokud jsou Osobni' European Economic Area (“EEA”). Where Personal
Lidaje pfedévany mimo EU nebo EHS, je takové Data is transferred outside the EU or the EEA, such
predava'ni pFedmétem odpovidajici ochrany, transfer is subject to an adequate protection,
zejména prostFednictvim pouiiti’ tzv. standardnich especially by the use of EU Standard Contractual
smluvni'ch doloiek EU. Clauses.
5.4 Poiadavky na informace. Zadatel informuje 5.4 Information reguirements. Requestor shall
dotceného clena personalu o zpracovani’ jeho inform the Personnel about processing of their
Osobnich Udajfi spolecnosti Merck, jejimi Personal Data by Merck, its affiliated companies and
pridruienymi spolecnostmi a poskytovateli sluieb service providers so that Merck and its affiliated
tak, aby spolecnost Merck a jeji pi‘idruiené companies comply with their information
spolecnosti splnily poiadavky Pfislusnych pra'vnich requirements under Applicable Data Protection Laws
pfedpisfi o ochrané osobnich ddajfi tykajici se towards Personnel. To this end, Requestor can use
ppskytovani informaci (pouéeni') vfiéi tomuto clenovi the template attached as Exhibit B.
personalu. Za timto ucelem mfiie Smluvni partner
pouiit vzor pfipojeny k této Smlouvé jako PFI’loha B.
5.5 - Dodriovani’ ptedpisfi o ochrané osobnich 5.5 Compliance with Data Protection Laws.
udajfi. Zadatel musi vidy dodriovat Pfislusné pravni Requestor shall at all times comply with Applicable
pfedpisy o ochrané osobni'ch ddajfi, pokud Data Protection Laws when processing Personal Data
zpracovava Osobni' udaje vsouvislosti stouto in connection with this Agreement.
Smlouvou.
5.6 Doby uchovavani’. Osobni Udaje souvisejici 5.6 Retention Periods The Personal Data
stouto Smlouvou budou uchova’va’ny tak dlouho, related to this Agreement will be stored for as long
dokud to bude vyiadovéno pro ucel stanoveny v ust. as it is required for the purpose set forth in Section
Chyba! Nenalezen zdroj odkazfi.. Kromé toho 5.2. Besides that, Personal Data will be stored to
budou Osobni Udaje uchovavany vsouladu comply with the relevant statutory retention periods
spfislusnymi zakonnymi lhfitami pro uchovavani such as applicable national commercial or tax laws.
ddajfi stanovenymi napf. pi’islusnym narodnim
obchodnim pravem nebo danovymi za'kony 6. Assignment
6. Postoupeni' The rights and obligations of Requestor under this
Pra’va a povinnosti Zadatele podle této Smlouvy jsou Agreement are personal to Requestor and may not
vazana na osobu Zadatele a nemohou byt be assigned or subcontracted to others without the
postoupena jiné osobé bez pisemného souhlasu Merck's written consent. The Merck Organization
spoieénosti Merck. Spolecnost Merck mfiie postoupit may assign this Agreement in whole or in part
without Requestor’s consent.
tuto Smlouvu vcelistvosti nebo jeji’ cast bez 7. Notices
pfedchazejiciho souhlasu Zadatele.
7. Oznamovéni Notices hereunder must be in writing and given to
the other Party by in-hand delivery; by electronic
Ozna’meni podle této Smlouvy musi byt uskuteénény mail; by facsimile; by first—class mail, postage
v pisemné formé a doruéeny druhé Strané do
vlastni’ch rukou; elektronickou postou; faxem; prepaid; or by air courier to the mailing address set
zasilkou prvni tfidy s predem zaplacenym forth above or to such other address as either Party
postovnym; nebo leteckym kuryrem na postovni may designate. Notices shall be effective when
adresu uvedenou vyse nebo na jinou adresu, kterou received.
uvede Strana. Oznameni se povaiuji za ucmna' dnem
doruceni. 8. Severability
8. Salvétorska klauzule If any provision of this Agreement is held to be
Kdyi se nékteré ustanoveni této Smlouvy stane invalid, void, or unenforceable, such provision shall
neplatnym nebo neucinnym, bude toto ustanoveni be deemed to be restated to reflect as nearly as
nahrazeno jinym tak, aby byl co nejvice zachovan possible the original intentions of the Parties in
accordance with Applicable Laws, and the remaining
pfivodni’ za'mér Stran v souladu s pfislusnymi provisions of this Agreement shall remain in full force
pfedpisy. Platnost a ucinnost ostatnich ustanoveni and effect.
zfistane nedotcena. 9. Term
9. Trvéni' Smlouvy 9.1 Term. This Agreement is valid from
2018-Oct-28 - 2018—Nov-3O
9.1 Trvani Smlouvy. Tato Smlouva je platna od
2018-OCt-28 - 2018-NOV-30 9.2 Survival. Expiry or termination of this
9.2 Pfetrva'ni. Uplynuti doby trvani nebo Agreement shall not relieve either Party of any
ukonceni Smlouvy nezbavuje fadnou 2e Stran obligation or liability accrued prior to the expiry or
povinnosti nebo zavazkfi, které vznikly pfed termination date. In addition to specific provisions
uplynutim doby twani’ nebo pred ukoncenim that survive pursuant to their own terms, the
Smlouvy. Kromé zvlastnich ustanoveni, ktera’ obligations of the Parties under the Sections entitled
pfetrvavaji na za'kladé jejich vlastni’ch podminek, Data Protection, Notices, Severability, and
povinnosti Stran vyplyvajici z clankfi Ochrana Lidajfi, Miscellaneous shall survive termination of this
Oznamovani, Salvatorska klauzule a Rfizna
Agreement.
ustanoveni’ pfetrvavaji vplatnosti i p0 ukonéeni
Smlouvy. 10. Withdrawal
10. Odstoupeni’ The Parties jointly declare that
Strany spolecné prohlasuji, ie a) failure to comply with the Merck
Organization’s instruction under this
a) nedodrieni ph’kazu spoleénosti Merck podle Agreement shall be considered by both of
této smlouvy budou Strany pokladat za them as fundamental breach of this
podstatné poruseni této Smlouvy. Agreement. In this event the Merck
Vtakovém pfi’padé ma spolecnost Merck Organization is entitled to withdraw from
prévo od této Smlouvy odstoupit podle § this Agreement pursuant to sec. 2002 of the
2002 zékona (“2. 89/2012 8b., obcanského Act No. 89/2012 Coll., Civil Code
za’koni’ku (da'le jen ,,ObEansky za'koni’k“). (hereinafter referred to as “Civil Code").
The withdrawal from this Agreement shall
Odstoupeni' od této Smlouvy musi byt be done in writing and delivered to
uéinéno vpisemné a doruéeno Zadateli Requestor (provision of sec. 573 of the Civil
(pficemi ustanoveni § 573 Obcanského Code is not excluded),
za'koni'ku neni’ vylouceno),
b) failure to prove the use of the Donation as
b) neprokazani’ pouiiti’ darova’ni tak, jak specified in this Agreement or use of the
stanovi tato Smlouva, nebo pouiitl darova’ni Donation for a different purpose as specified
in this Agreement shall be considered by
pro jiny ucel, nei je stanoveny vtéto both of them to be an apparent violation of
Smlouvé, bude obéma pokladano za zjevné good morals, which entitles the Merck
Organization to withdraw from this
poruseni' dobrych mravfi, které opravnuje Agreement and to demand the return of the
Donation for the Requestor’s ingratitude in
spolecnost Merck odstoupit od te'to accordance with § 2072 of the Civil Code.
Smlouvy a poiadovat vraceni pfedmétu The withdrawal from this Agreement shall
darova’ni pro nevdék Zadatele v souladu se be done in writing and delivered to the
znénim § 2072 Obéanského zakoni’ku. Requestor (provision of sec. 573 of the Civil
Code is not excluded).
Odstoupeni' od této Smlouvy musi byt
uéinéno vpisemné a doruceno Zadateli
(pFicemi ustanoveni § 573 Obcanske’ho In the cases above the Requestor is obligated to
zakoniku neni vylouceno). return the Donation without undue delay from the
date of receipt of the withdrawal.
Ve vyse uvedenych ph’padech je Zadatel povinny 11. Miscellaneous
vratit pFedmét darova’ni bez zbytecného odkladu ode
dne doruceni oznameni o odstoupem’ od smlouvy.
11. Rfizné ustanoveni This Agreement, including the Donation for Patient
Benefit Request Form filed by Requester, which is
Tato Smlouva, véetné formulare zédosti o darovani hereby incorporated by reference, is the entire
ve prospéch pacienta, vypinéna Zadatelem, ktera je agreement between the Parties relating to the
vclenéna do této Smlouvy odkazem na ni, subject matter hereof and supersedes all prior
ptedstavuje L'Iplnou dohodu mezi Stranami tykajici se agreements between the Parties relating to the
ptedmétu Smlouvy a nahrazuje veskeré subject matter hereof. The parties declare that they
predchézejici dohody mezi Stranami k danému
predmétu Smlouvy. _Smiuvni strany prohlasuji, 2e communicated to each other all information, which
si vza’jemné oznamily vsechny informace, které they consider important and essential for concluding
povaiuji za dfileiité a nezbytné pro uzavFenI' této
Smlouvy. Smluvni' strany se dohodiy, ie podstatna’ this Agreement. The parties agreed that the material
zména okolnosti, za kterych byla tato Smlouva
uzavi’ena, neopravhuje iadnou 2e Stran poiadovat change of circumstances, under which this
obnovu Jednani o této Smlouvé ve smyslu Agreement was concluded, does not entitle any of
Obcanského za’kom’ku. zadna’ dohoda, kterou se the parties to require renovation of the negotiation
pozménuji ustanoveni této Smlouvy nebo v ra’mci about this Agreement within the meaning of sec.
které docha'zi ke vzda’ni' se na’rokfl z této Smlouvy, 1765 of the Civil Code. No agreement modifying or
neni zavazna, jestliie nenI' uskutecnéna pisemné waiving any provision of this Agreement shall be
s odkazem na tuto Smlouvu a podepsa’na Stranami. binding unless made in a writing that references this
Tato Smlouva a vsechny na’roky 2 hi vyplyvajici se Agreement and is signed by the Parties. This
Fidi ceskymi pravnimi pFedpisy. Strany se zavazuji, Agreement and all claims related to it shall be
ie vsechny spory vzniklé v souvislosti s touto
Smlouvou budou Fesit smirne. Pokud by takova’ governed by the Czech laws. The Parties undertake
smirna dohoda nebyla moina’, budou spory Fesené to resolve amicably all disputes that arise in
ph’slusnymi soudy Ceské republi connection with this Agreement. If an amicable
agreement is not possible, disputes shall be resolved
iADATEL / REQUESTOR by the relevant courts of the Czech Republic.
Podpis / Signature: SPOLECNOST /
Jméno (Citelné) / Printed name: Podpis/ Signatur
Jméno (iitelné)/P
Funkce/Title: acmmVI/II‘ nffiil Funkce/ Title: M
Datum/ Date:
3’ 43- 20m
Datum / Date:
Kraiské 7dravoini a 5. Podpis/ Signatur
SntIa'lrIip 5': 33 l6/12A
1401 I3 lisii nar‘ Labem Jméno (citelné)/P
-C: zsaagnw Funkce / Title: M
L‘\ CI...“ :2? Jun
Datum / Date: -\ I r\
)3
i
pfiiLOHA A / EXHIBIT A
FORMULAI‘I iADOSTI DARovANi NA PODPORU sAVOTNi PééE /
HEALTHCARE-RELATED DONATION REQUEST FORM
Datum podéni 22.10.2018
/ Date Submitted:
Jméno zéstupce iadatele generélni Feditel KZ
/ Requestor Representative’s Name:
TelefonniIvc;rslo iadatele
/ Requestor's Phone Number:
iadajici organizace ("iadatel") Krajské zdravotni, a.s., (Isti nad Labem
/ Requesting Organization (“Requestor”):
vyée poiadovaného pi‘ispévku 300,000.00 KE
/ Amount of Contribution Requested:
(“:isio bankovniho aétu
/ Bank account number:
Datum programu/akce (je-li relevantni) N/A
/ Date of Program/Event Sponsored (if
relevant):
Detailni popis daru ve prospéch Rehabilitation aid for hip and knee joint, used mainly
pacienta
/ Detailed Description of Donation for to prevent joint harm due to immobilization, and for
Patient Benefit: therapy progress acceleration and Medical motoric
device for upper and lower limbs, actively passive
Poskytnuté prfivodni dokumenty trainer for limbs strengthening and improvement oj
/ Supporting Documents Provided: joint mobility.This will help to patients to improve the
movement condition and increase their quality of life.
iédost o darovéni
Formular iadosti o darova’ni ve prospéch pacienta zasiete spolu s prfivodnimi dokumenty a touto stra’nkou na
adresu / Send Donation for Patient Benefit Request Form with supporting documents and this page to:
Merck spol. s r.o.
Na Hrebenech II 1718/10
140 00 Praha
Niie uvedenym podpisem potvrzujete, ie: Your signature below confirms that:
v pfipadé, kdy Vém bude dar ve prospéch awarded, this Donation for Patient Benefit is
pacienta poskytnut, nebyl tento prijat jako not being received as a reward or in exchange
odména nebo jako protisluiba za doporuéeni, for recommending, prescribing, dispensing,
piedepisovéni, vydavani, nakupovani, dodévéni, purchasing, supplying, selling, administering,
prodej, podévéni, posiléni, dojednéni nebo referring, arranging for, or ordering
objednavéni farmaceutickych produktfl nebo
jako pobidka k doporuéeni, pi‘edepisovéni, Pharmaceutical Products, or to induce
vydévéni, nakupovani, dodévani, prodeji, recommending, prescribing, dispensing,
podévéni, posiléni, dojednéni nebo objednévéni purchasing, supplying, selling, administering,
farmaceutickych produktfi v budoucnosti. referring, arranging for, or ordering
Vezméte prosim na védomi, ie v tuto chvili nebyl Pharmaceutical Products in the future. Note
uEinén iédny pfislib ve véci podpory tohoto that at this time no commitment has been
programu made to support this program.
Potvrzuji, 2e jsem piné opravnén/a pOdat tuto iédost I certify that I am fully authorized to submit this
0 darovani ve prospéch pacienta a poskytnout Donation for Patient Benefit Request and provide
uvedené informace jménem Zadatele a jakékoliv the information in the request on behalf of
partnerske' organizace/organized a potvrzuji, ie Requestor and any partner organization(s), and I
vsechny odpovédi a informace poskytnuté v této affirm that all responses and information provided
ia’dosti jsou pravdivé, piesné a Uplné. in this request are truthful, accurate, and complete.
Za / On behalf of
Podpis /Signature: ‘ Krajské zdravotni.a.s.
Jméno (éitelné)/ Printed n
SOClcilni’péigi 3316/12A
Funkce / Title: generaini' Feditel KZ
Datum / Date:22.10.2018 401 13USI? Had Labem
lO a iC: 25488027
\ oat: c2 25a88627
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