Ameri- can Thoracic Society, 1. Key definitions Authorized Users Outsource Provider Effective Date Fee Licensed Material Licensee

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This License Agreement is agreed this day of, 20 between the American Thoracic Society, located at 25 Broadway, 18 th floor, New York, NY 10004 ( the Publisher ) and, ( the Licensee ) located at: WHEREAS the Publisher holds the rights granted under this License Agreement AND WHEREAS the Licensee desires to use the rights and the Publisher desires to grant to the Licensee the license to use the rights for the Fee in schedule 1. IT IS AGREED AS FOLLOWS: 1. Key definitions In this License Agreement, the following terms shall have the following meanings: 1.1 Authorized Users Students, employees, agents, contractors and Outsource Providers of the Licensee (whether on a permanent, temporary or contract basis) who are permitted by the Licensee to access the Secure Network from within or outside the Licensee s premises, whose identity is authenticated at the time of login and periodically thereafter consistent with current best practice, and whose access to the Licensed Material is subject to regulation by the Licensee. Others granted access to library materials at academic institutions, including through Inter-Library Loan, shall also be considered Authorized Users for purposes of this Agreement. 1.2 Outsource Provider means a third party appointed by the Licensee to provide services to the Licensee and its Affiliates or Authorized Users only as it relates to the subject matter of this Agreement and only for the benefit of the Licensee. 1.3 Effective Date The date this License Agreement has been signed by both parties. 1.4 Fee The fee set out in Schedule 1, as amended by mutual agreement of the parties from time to time. Payment terms shall be within thirty (30) days after invoice date. 1.5 Licensed Material The electronic material listed in Schedule 1, as amended by mutual agreement of the parties from time to time, and which is delivered in the format and according to the time schedule specified in Schedule 1. 1.6 Licensee This term includes the Licensee as first named above, and its Affiliates: Affiliates shall mean with respect to either party any corporation, partnership or other entity which at the effective date or afterwards (i) controls directly or indirectly such party, (ii) is directly or indirectly controlled by such party, or (iii) is under common control with such party. "Control" shall mean direct or indirect ownership of more than 50% of the capital stock or the voting rights in such corporation, partnership or other entity.

1.7 Secure Network A network operated or controlled by the Licensee (whether a standalone network or a virtual network within the Internet) which is accessible only to Authorized Users. 2. Grant of License 2.1 The Publisher hereby grants to the Licensee the non-exclusive and world-wide right to give Authorized Users access to the Licensed Material via the Secure Network, subject to payment of the Fee by the Licensee and to the other terms and conditions of this License Agreement. 2.2 In consideration of the rights granted under this License Agreement, the Licensee shall pay the Fee to the Publisher in accordance with the provisions of Schedule 1. The Fee shall be exclusive of any sales, use, value added or similar taxes, and the Licensee shall be liable for any such taxes in addition to the Fee. 2.3 This License Agreement shall commence on the Effective Date and, unless earlier terminated pursuant to clause 8 below, shall remain in effect for an initial term of one (1) year. The Agreement shall automatically renew for a term of one (1) year each year thereafter, unless notice of non-renewal is given by either party to the other at least thirty (30) days prior to any renewal date. The Publisher shall give the Licensee notice of any fee increase or other changes to the terms of the Agreement for the renewal term at least sixty (60) days prior to the renewal date. 2.4 Outsourced Provider The Licensee shall have the right to appoint a third party to provide services to the Licensee and its Affiliates or Authorized Users (an Outsource Provider ) only as it relates to the subject matter of this Agreement and only for the benefit of the Licensee ( Outsourced Services ). Notwithstanding anything in this Agreement to the contrary; the Licensee may permit the Outsource Provider in the performance of the Outsourced Services to access, operate and use any product supplied or licensed under this Agreement, and to receive and use any services provided under this agreement only for the Licensee s benefit; and otherwise permit the Outsource Provider, in its performance of the Outsourced services, to do anything that the Licensee and its Affiliates or Authorized Users are not precluded from doing under the Agreement in order to perform the Outsourced Services. Outsourced Provider will be included in the count of Authorized Users. 3. Permitted uses 3.1 The Licensee may, subject to Clause 4 below: 3.1.1 Allow Authorized Users to have access to the Licensed Material via the Secure Network on a concurrent basis. 3.1.2 Use the Licensed Materials as part of an integrated information service for Authorized Users that will include links between the Licensed Materials and the Licensee s own indexes, third party abstracting and indexing services and other information resources utilised by the Licensee. 3.1.3 Provide single printed or electronic copies of single articles at the request of Authorized Users, including through Inter-Library Loan ( ILL ) if the Licensee has previ- 2

ously submitted a list of ILL users to the Publisher and has received approval for ILL distribution (note that approval for ILL distribution is subject to an additional fee, as shown on Schedule 1). 3.1.4 Use a reasonable portion of Journal content, in printed or digital format, in the preparation of educational materials and in other articles or materials, so long as the Journal is properly cited. The user must contact the ATS at ats.permissions.org if figures or tables are being requested for use in a manuscript that will be submitted for publication. 3.1.5 Store electronic copies of the Licensed Materials as necessary solely to ensure efficient use by Authorized Users. 3.1.6 Store and provide print or electronic copies of the Licensed Materials to national or international regulatory authorities for the purposes of, or in anticipation of, regulatory approval or patent and/or trademark applications or other legal or regulatory purposes. 3.1.7 Supply print or electronic copies of individual items taken from the Licensed Materials when required by law for use in legal proceedings. 3.1.8 Maintain perpetual access to Licensed Materials obtained during the term of this License Agreement, including after cancellation of the subscription/termination of the Agreement. 3.2 Authorized Users may, subject to clause 4 below: 3.2.1 Search, view, retrieve and display the Licensed Materials. 3.2.2 Electronically save parts of the Licensed Materials for personal use. 3.2.3 Print off a copy of individual articles or items of the Licensed Materials. 3.2.4 Distribute a copy of individual articles or items of the Licensed Materials in print or electronic form to another Authorized User. (Note that mass distribution, including in professors course packs, is allowed subject to payment of additional fees. Please contact the Copyright Clearance Center for our charges.) 4. Prohibited uses 4.1 Neither the Licensee nor Authorized Users may remove or alter the authors names or affiliations or the Publisher s copyright notices or other means of identification or disclaimers as they appear in the Licensed Material. 3

4.2 Neither the Licensee nor Authorized Users may systematically make copies of multiple extracts of the Licensed Material for any purpose other than as explicitly permitted under clauses 3.1 and 3.2 of this License Agreement. 4.3 Neither the Licensee nor Authorized Users may provide or make available by electronic means to any third party who is not an Authorized User a retained electronic copy of any part of the Licensed Material other than as permitted under Section 3. 4.4 Neither the Licensee nor Authorized Users may mount or distribute any part of the Licensed Material on any electronic network, including but not limited to the Internet and the World Wide Web, other than the Secure Network other than as permitted under Section 3 above. 4.5 The Licensee and Authorized Users may not, without the Publisher's explicit written permission: 4.5.1 Use the whole or any part of the Licensed Material for sale, reward or exploitation other than as expressly permitted by this License Agreement. 4.5.2 Distribute the whole or part of the Licensed Material to anyone other than Authorized Users or for any purpose not expressly authorized by this License Agreement other than as permitted under Section 3 above. 4.5.3 Publish, distribute or make available the Licensed Material, works based on the Licensed Material or works which combine it with any other material, other than as permitted in this License Agreement and except for a reasonable amount of writing which is properly cited and does not amount to the systematic copying of the Licensed Material. 4.5.4 Alter, abridge, adapt or modify the Licensed Material, except to the extent necessary to make it perceptible on a computer screen to Authorized Users. For the avoidance of doubt, no alteration of the words or their order is permitted. 5. Publisher s undertakings 5.1 The Publisher shall: 5.1.1 Make the Licensed Material available to the Licensee and to Authorized Users from the Publisher s server in the format and time schedule specified in Schedule 1. 5.1.2 Make available to the Licensee any published updates or new versions of the Licensed Material. 5.1.3 Provide the Licensee, according to the schedule set forth in Schedule 1, with information sufficient to enable access to the Licensed Material. 5.1.4 Make available to the Licensee all content that is available in the print version. If print content - such as supplements, review articles - does not appear in the online version a paper copy of the material will be supplied to at least one nominated site with permission to distribute this electronically to any Authorized User. 5.2 The Publisher shall use all reasonable endeavours to: 5.2.1 Make the Licensed Materials available to the Licensee and to Authorized Users at all times and on a twenty-four hour basis, save for routine maintenance (which shall be notified to the Licensee in advance wherever possible). 4

5.2.2 Ensure that its server has adequate capacity and bandwidth to support the commercially reasonable usage of the Licensee at a level commensurate with the standards of availability for information services of similar scope operating via the World Wide Web; as such standards evolve from time to time over the term of this License Agreement. 5.2.3 In the event of unscheduled interruption of access to data, make best efforts to restore the Licensee s access to data within two (2) hours. 5.2.4 Inform the Licensee of scheduled interruptions and their duration fourteen (14) days in advance. The Publisher shall make best efforts to restrict such interruptions to less than three (3) per year. 5.2.5 Provide the Licensee with adequate and competent technical support and assistance to enable the Licensee to use the Licensed Material as contemplated hereby including operating a help desk for all Authorized Users between 9 a.m. and 5 p.m. ET. 5.3 The Publisher reserves the right at any time to withdraw from the Licensed Material any item or part of an item which it no longer retains the right to publish, or which it has reasonable grounds to believe infringes copyright or is defamatory, obscene, unlawful or otherwise objectionable. The Publisher shall give written notice to the Licensee of such withdrawal. If the withdrawn material represents more than 10% of the individual journal issue in which it appeared, the Publisher shall make a pro rata refund of part of the Fee, taking into account the amount of material withdrawn and the remaining unexpired portion of the License Agreement Period. 5.4 The Publisher warrants that after the exercise of all reasonable care to the best of its knowledge and belief the Licensed Materials contain no virus or other unauthorized or harmful program, code or routine, and will use its best endeavours to ensure that no software commands that will corrupt, delete or make unreadable other computer files stored on the Secure Network will be inserted by it into the Publisher s electronic files delivered or accessed under the terms of this License Agreement. 5.5 If the Licensee is accessing the Publisher s server and system under this License Agreement, the Publisher warrants that such system will perform consistently with the written specifications or descriptions of such system. 5.6 If the Licensee is accessing the Publisher s server and system, and if the Publisher utilizes software for that system produced by a third party software vendor, the Publisher shall provide such warranties as are provided to the Publisher by such vendor. 5.7 If notwithstanding the warranties in 5.6 and 5.7 above, any harmful virus within the Licensed Material and attributable to the Publisher or attributable to its software, or attributable to the Publisher's related suppliers including without limitation software suppliers, should come to light during the Term of this License Agreement, the Licensee shall have the option either: (a) to require the Publisher to make or require from the Publisher s software supplier such repairs or modifications as may be necessary to remove or correct the said virus within 30 days of receiving written notice from the Licensee to do the same, or (b) to terminate this License Agreement under the terms of clause 8 below. 5

5.8 The Publisher warrants that it is permitted to deliver the Licensed Material and that the Licensed Material it delivers is complete. 6 Licensee s undertakings 6.1 The Licensee hereby undertakes that it will not itself or by its employees, agents or contractors intentionally commit, procure or be involved in the commission of any material or persistent breach of the Publisher s intellectual property or other proprietary rights relating to the Licensed Materials. 6.2 The Licensee shall: 6.2.1 Ensure that all Authorized Users are made aware of the terms and conditions of this License Agreement which directly relate to the Authorized Users use of the Licensed Material. 6.2.2 Use all reasonable endeavours to monitor compliance and immediately on becoming aware of any unauthorized use or other breach, take all reasonable steps, to ensure that such activity ceases immediately, and inform the Publisher thereof. 6.2.3 Ensure that only Authorized Users are permitted access to the Licensed Material and if appropriate notify the Publisher within a reasonable period of any person ceasing to be an Authorized User. 7 Mutual undertakings Each party shall safeguard the intellectual property, confidential information and proprietary rights of the other party. In particular, but without limitation all commercial and financial terms and conditions of this License Agreement which are specific to the agreement between the parties, including without limitation the content of all the Schedules hereto, shall be kept strictly confidential. 8 Termination 8.1 This License Agreement may be terminated only as follows: 8.1.1 If the Licensee defaults in making payment of the Fee. 8.1.2 If either party or any of its current employees or agents commits a material or persistent breach of any term of this License Agreement and fails to remedy the breach (if capable of remedy) within thirty (30) days of notification in writing by the other party. 8.1.3 Either party becomes insolvent or becomes subject to receivership, liquidation or similar external administration. 8.2 On termination all rights and obligations of the parties automatically terminate except for: 8.2.1 Those specified in Clauses 5.1 and 7 above. 8.2.2 All obligations in respect of Licensed Material to which access continues to be permitted (i.e., perpetual access pursuant to Clause 3.1.8). 8.3 On termination of this License Agreement due to breach of any material term thereof by the Licensee, the Licensee shall immediately cease to distribute or make available the Licensed Material to Authorized Users. 9. General 6

9.1 This License Agreement contains the full and complete understanding between the parties and supersedes all prior arrangements and understandings whether written or oral appertaining to the subject matter of this License Agreement. All Schedules hereto are incorporated as if set forth in this License Agreement in full. 9.2 Alterations to this License Agreement are only valid if they are recorded in writing and signed by both parties. 9.3 Except for assignments to Affiliates for structural, organizational or tax reasons when consent shall not be required, this License Agreement may not be assigned by either party to any other person or organization, nor may either party subcontract any of its obligations, without the prior written consent of the other party, which consent shall not unreasonably be withheld. Either party may make its consent conditional on the agreement of the assignee to maintain the confidentiality of (or, at that party's election, destroy) all usage information collected by the other party. 9.3.1 If rights in all or any part of the Licensed Material are assigned to another publisher, the Publisher shall use its best endeavours to ensure that the terms and conditions of this License Agreement are maintained. 9.4 Any notices to be served on either of the parties by the other shall be sent by third party carriers, who must obtain a signed receipt, to the address of the addressee as set out in this License Agreement or to such other address as notified by either party to the other as its address for the service of notices. 9.5 Neither party shall be liable in any way for failure or delay in performing its obligations under this License Agreement if the failure or delay is due to causes outside the reasonable control of the party in default. 9.6 The failure of any party to enforce any provision on any one occasion shall not affect its right to enforce another provision or the same provision on another occasion. 9.7 EXCEPT FOR BREACH OF ACCESS OR BREACH OF CONFIDENTIALITY, NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR ANY SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES (INCLUDING, WITHOUT LIMITATION, LOST PROFITS AND LOSS OF GOODWILL) ARISING FROM ANY BREACH OF THIS LICENSE AGREEMENT, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. 9.8 In the event that any provision of this License Agreement is held to be invalid, the remainder of the provisions shall continue in full force and effect. 9.9 This License Agreement is for the sole benefit of the parties and does not confer any rights in any other persons except as provided in this License Agreement. 9.10 This License Agreement shall be governed by and construed according to the laws of The United States, specifically New York State and the parties irrevocably agree to submit to this jurisdiction only. 7

The signatures of the authorized representatives of the parties below demonstrate the parties acceptance of the terms and conditions of this Agreement. For the Publisher Name (in block capitals): STEPHEN C. CRANE Title: EXECUTIVE DIRECTOR Signature: Date: For the Licensee Name (in block capitals): Title: Signature: Date: 8

Schedule 1 - Licensed Materials and Fees Description of Licensed Delivery Schedule Fee Payment Terms Material & Format AJRCCM Multi SITE Tier 3 +Print (Non USA Only) AJRCMB Multi SITE Tier 3 (Online Only) As Published As Published 30 days after invoice date 30 days after invoice date AnnalsATS As Published 30 days after invoice date ILL Distribution Within 5 business days of print publication Articles from the journal are available for interlibrary loan (ILL) at a cost of $20.00 per use through pay per view at www.atsjournal s.org or through the copyright clearance canter at www.copyright. com At the time of article download. 9