Form ID

Publication date

Location of premises

Certificate

Project #: R-416-03 Recycled Asphalt Crushing at Public Works Yard, Dunfield Road

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the Town of Kirkland Lake
Address of Owner
1 Dunfield Road, Postal Bag 1757, Kirkland Lake, ON P2N 3P4
Name of Contractor
Teck Northern Roads Ltd.
Address of Contractor
PO Box 400, Kirkland Lake, ON P2N 3J1
Name of Certifier
Owner
Address of Certifier
as owner

Office to which claim for lien must be given to preserve lien

Owners address