Form ID

Publication date

Location of premises

Certificate

Contract No. 17 111 02157 -

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Mississauga
Address of Owner
3185 Mavis Rd., Mississauga, ON L5C 1T7
Name of Contractor
Bob Hendricksen Construction Ltd.
Address of Contractor
12051 Ashburn Rd., RR #4, Uxbridge, ON L9P 1R4
Name of Certifier
E. Savini, P. Eng.
Address of Certifier
3185 Mavis Road, Mississauga, Ont. L5C 1T7.

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

City of Mississauga - 300 City Centre Drive, Mississauga, Ont. L5B 3C1.