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O� SJNNY JS(FSO <br />♦ oOP� <br />hF s9�. FLOR` ybr <br />C�tY OF 5U0 PNO <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 />BY' <br />Titl ief Operating Officer <br />The foregoing instrument was acknowledged before me this 3rd day of <br />January 1 20 12 f by Kenneth Cooke [name <br />of person], as Chief Operating Officer [type of authority], for <br />Intermedix Corporation [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />pty NNEKA NNOLIM <br />Notary Public • State of Florida <br />My Comm. Expires Apr 6, 2014 <br />��:FOrv��:••' Commission # DD 978636 <br />("160 �'IIL106 <br />otary Pu lic — State of Florida <br />NNt-,K A NNOLIM <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 />