Form ID

Publication date

Location of premises

Certificate

Supply & Install Two (2) Inline Blenders and Reservoir Bafflewalls

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Regional Municipality of Peel
Address of Owner
10 Peel Centre Dr., Brampton, ON Attn: Mike Kyne
Name of Contractor
Tenebac Ltd.
Address of Contractor
325 Central Parkway West, Mississauga ON L5B 4A7
Name of Certifier
Tony Mellegers, CET, CST, KMK Consultants Limited
Address of Certifier
220 Advance Boulevard, Brampton Ontario L6T 4J5

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

Office of the Owner