Boeing Commercial Airplanes (BCA) Terms and Conditions
DAC 26-628 (06-89) Page 1 of 1
ROYALTY INFORMATION REPORT
___________________________________________
_______________________
____________________________
SELLER NAME
TELEPHONE
SELLER CODE
__________________________________
_______________________
______
___________
___________________
STREET ADDRESS
CITY
STATE
ZIP
NO. OF EMPLOYEES
______________________________________________
_________________________________
PARENT COMPANY
ADDRESS
THIS FIRM IS
INDEPENDENTLY OWNED AND OPERATED
AN AFFILIATE
SUBSIDIARY OF
DIVISION
ROYALTY INFORMATION REPORT
THE GOVERNMENT HAS ACQUIRED LICENSES AND OTHER RIGHTS UNDER A LARGE NUMBER OF INVENTIONS. IN ORDER THAT THE GOVERNMENT MAY DETERMINE WHETHER THE CHARGING OF ROYALTIES TO THE GOVERNMENT IS INCONSISTENT WITH THE RIGHTS WHICH THE GOVERNMENT HAS ACQUIRED OR IS OTHERWISE IMPROPER IT IS ESSENTIAL THAT ROYALTY INFORMATION BE FURNISHED THE GOVERNMENT WHENEVER COSTS OR CHARGES FOR ROYALTIES TOTAL MORE THAN $250.
IF COSTS OR CHARGES FOR ROYALTIES TOTAL MORE THAN $250, THE FOLLOWING INFORMATION SHALL BE FURNISHED ON EACH SEPARATE ITEM OF ROYALTY OR LICENSE FEE:
NAME AND ADDRESS OF LICENSOR ______________________________________________________________________________
DATE OF LICENSE AGREEMENT _________________________________________________________________________________
PATENT NUMBERS, PATENT APPLICATION SERIAL NUMBERS, OR OTHER BASIS ON WHICH THE ROYALTY IS PAYABLE __________ ____________________________________________________________________________________________________________
BRIEF DESCRIPTION, INCLUDING ANY PART OR MODEL NUMBERS FOR EACH CONTRACT ITEM OR COMPONENT ON WHICH THE
ROYALTY IS PAYABLE _________________________________________________________________________________________
PERCENTAGE OR DOLLAR RATE OF ROYALTY PER UNIT ____________________________________________________________
UNIT PRICE OF CONTRACT ITEM ________________________________________________________________________________
NUMBER OF UNITS ___________________________________________________________________________________________
TOTAL DOLLAR AMOUNT OF ROYALTIES _________________________________________________________________________
THE FURNISHING OF COPIES OF APPLICABLE PATENTS, PATENT APPLICATIONS, OR LICENSE AGREEMENTS AT NO COST WILL EXPEDITE THE EVALUATION OF QUOTATIONS. (COPIES FURNISHED WILL NOT BE RETURNED.)
SELLER HEREBY CERTIFIES THAT THE ITEMS OFFERED HEREIN DO DO NOT CONTAIN COSTS OR CHARGES TOTALING MORE THAN $250.
__________________________________________
_____________________________________
_________________
SIGNATURE
TITLE
DATE
NOTE: THE TERM "ROYALTIES" REFERS TO ANY COSTS OR CHARGES IN THE NATURE OF ROYALTIES, LICENSE FEES, PATENT OR LICENSE AMORTIZATION COSTS, OR THE LIKE, FOR THE USE OF OR FOR RIGHTS IN PATENTS OR PATENT APPLICATIONS.
