Okaloosa County BOCC — March 15, 2016 — Delivery & Acceptance Certificate

Philips Medical Capital Delivery and Acceptance Certificate PHONE: (866) 514-4PMC « FAX: (866) 516-4PMC Full Legal Name _Okaloosa County i w a Billing Address 302 North Wilson Street, Suite 203 Phone Number 8506895960 w — city _Crestview County State __FL Zip Code 32536 = Z S| street Address 714 Essex Road 2e 5§ city Fort Walton Beach County State FL Zip Code 32547 With respect to that certain Master Lease Agreement dated _ January 19,2016 and Master Lease Schedule No._01 , dated _January 19, 2016 , related thereto (collectively, the “Agreement”), between Philips Medical Capital, LLC and the above referenced Lessee, Lessee by its signature hereto certifies that it has a reasonable period of time to inspect the System and that each item of the System has been delivered, installed and accepted. In addition, the Lessee agrees that the System and each such item thereof is in good condition and satisfactory for all purposes of the Agreement. The person signing below represents and warrants that he/she is authorized to deliver this document on behalf of Lessee. YOU AGREE THAT A FACSIMILE COPY OF THIS DOCUMENT WITH FACSIMILE SIGNATURES MAY BE TREATED AS AN ORIGINAL AND WILL BE ADMISSI- BLE AS EVIDENCE IN A COURT OF LAW. Signature X Print Name _X Title X Date LESSEE SIGNATURE Legal Name of Corporation_Okaloosa County THE ABOVE SIGNATORY AFFIRMS THAT HE/SHE IS A DULY AUTHORIZED CORPORATE OFFICE OR OFFICIAL, PARTNER OR PROPRIETOR OF THE ABOVE NAMED LESSEE. ©2005 All Rights Reserved. Printed in the U.S.A. 05PHIL548A 12/05 05PHIL548A