Form ID

Publication date

Location of premises

Certificate

Roof Replacement (Roof A)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Regional Municipality of Waterloo
Address of Owner
150 Frederick St., Kitchener, ON
Name of Contractor
Palmer Roofing & Insulation Ltd.
Address of Contractor
1004 Industrial Cr., St. Clements, ON N0B 2M0
Name of Certifier
N. American Roof Management Services Ltd.
Address of Certifier
726 Wilkins St., London, ON N6C 4Z7

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

Regional Municipality of Waterloo