Form ID

Publication date

Location of premises

Certificate

Project # R393-00 Asphalt Crushing and Hauling

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
Address of Contractor
56 Rand Avenue West, Kirkland Lake, ON P2N 3J1
Name of Certifier
Owner
Address of Certifier
As above

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

Owners Address