Form ID

Publication date

Location of premises

Certificate

09-139 - Mississauga A - Certicom Retrofit

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Certicom LP2
Address of Owner
295 Phillip Street, Waterloo, ON N2L 3W8
Name of Contractor
Melloul Blamey Construction Inc.
Address of Contractor
700 Rupert Street, Unit A, Waterloo, ON N2V 2B5
Name of Certifier
Robertson Simmons Architects Inc.
Address of Certifier
130 Weber Street West, Suite 100, Kitchener, ON N2H 4A2

Identification of Premises

4701 Tahoe Blvd., Mississauga, Ontario L4W 0B5

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

as per part A