Fillable Geothermal-Contractor-Certification

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Geothermal-Contractor-Certification

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U.S.A. forms for Borough of Collegeville

BROWSE BOROUGH OF COLLEGEVILLE (PA) FORMS

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BOROUGHOFCOLLEGEVILLE
GEOTHERMALHEATING/COOLINGSYSTEMINSTALLATION
CONTRACTORCERTIFICATION
___________________________________________________herebycertifies
(Authorizedcompanyrepresentative,companynameandaddress)

thatthegeothermalheating/coolingsystemdrillinganddrillingrelatedactivities
performedat_________________________________,Collegeville,PA19426

(address)
conformedtocurrentindustryinstallationstandardsandcompliedwithCollegeville
BoroughOrdinanceNo.548.
___________________________________________
AuthorizedCompanyRepresentative
___________________________________
Date
Onthis_________________dayof________________________,beforeme,theundersignedofficer,
a Notary Public, personally appeared _____________________________, known to me to be the
____________________________________________________, whose name is subscribed to the within
instrument, and acknowledged that he executed the same on behalf of ______________________ for the
purposesthereincontained.
INWITNESS
WHEREOF,Ihavehereuntosetmyhan dand officialseal.
_______________________________
NotaryPublic
MyCommissionexpires:
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Geothermal-Contractor-Certification

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Completed 12 July 2020

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