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SJp1_tJY fS <E <br />s <br />� +rtoa <br />or Su" Pr�O <br />STATE OF FLORIDA ) <br />COUNTY OF Broward ) <br />ANTI - KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />ANTI - KICKBACK AFFIDAVIT <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br />will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br />commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br />by an officer of the corporation. <br />B - <br />_ <br />Titl . ief Operating Officer <br />The foregoing instrument was acknowledged before me this <br />January <br />of person], as <br />Intermedix Co <br />executed]. <br />_1 20 12 f by Kenneth Cooke <br />Chief Operating Officer [type of <br />Dration [name of party on behalf of whom <br />AFFIX NOTARY STAMP HERE: <br />A PU <br />a °off S is <br />NNEKA NNOLIM <br />a `r` <br />s' Notary Public - State of <br />My Comm. Expires Apr 6, Florida 2014 <br />Commission # DD 979636 <br />3rd day of <br />[name <br />authority], for <br />instrument was <br />otary Pu uc — State of Florida <br />NNEKA M(\jOLIM <br />Print or Type Commissioned Name <br />Personally Known X OR Produced Identification <br />Type of Identification Produced N/A <br />DECEMBER 28, 2010 7 of 7 <br />