MECHANICAL FITNESS ASSESSMENT

As required by Vehicle Inspection Regulation (A/R 211/2006)

Dealer: Waterloo Ford Lincoln AMVIC Licence Number: 14416
Address: 11420-107 Avenue NW, Edmonton Alberta
VEHICLE INFORMATION
Year : 2012 Make: HONDA Model: CIVIC Previous Province of Registration:

Vehicle Identification Number: 2HGFBN2F44CH049052 Odometer Reading: 84383 ✔ ( km / mi )

m Truck m Motorcycle m Bus m Van m Light Truck m Auto

✔ m Motorized RV m Other
Please check mark () each item as C=Complies or N=Non-Compliant. If item is Not Applicable indicate as N/A in the C column
Powertrain C N Brakes C N Frame & Body C N
Accelerator Parking/Emergency Brake Hood Latch
Fuel System Hydraulic System Door Latches & Hinges
Exhaust Vacuum System Bumpers
Transmission Drum Brakes Windshield Wipers & Washer
Front/Rear/Spindles Axles Disc Brakes Rear Wiper & Washer
Clutch Shoes/Pads Windshield
Fluid Levels (power steering, brake) Anti-Lock (if OEM equipped) Windows
CV Joints Defrost/Heaters
Steering C N Mirrors
Lamps C N Steering Lash
Head Lamp Hi Beam Seats
Steering Linkage Seat Belts/Airbags
Head Lamp Lo Beam Rack & Pinion
Head Lamp Location Mudguards
Power Steering System Window Glazing
Daytime Running Lamps King Pin
Tail Lamps Structural Integrity
Ball Joints
Brake Lamps Tires & Wheels C N
Turn Signal Lamps Suspension C N Tread Depth
Hazard Warning Lamps Leaf springs Tread Section
Licence Plate Lamp Struts and Shocks Sidewalls
Back-up Lamps Coil spring Wheels
Torsion Bar
Instruments C N Independent/Multilink Rear Electrical C N
Speedometer/Odometer Computer Controlled Wiring
Indicator Lamps Battery
Horn Diagnostic C N Switches
Hi Beam Indicator Diagnostic Trouble Codes Alternator
Technician Comments

This is to certify that I have assessed the vehicle described above in accordance I, the buyer of this vehicle, acknowledge
with the Traffic Safety Act, Vehicle Equipment Regulation (A/R 122/2009). By receipt of this assessment.
signing this assessment, I verify the contents of this document are true and correct.
Signature of Buyer
Signature of Certified Journeyman Technician:
Buyer (Print)
Technician Name (Print): LONNY BANCESCU
Signature of Salesperson
revised 09/15/2014

Technician Trade Certificate Number: H-13-96326

Salesperson (Print)
Date: MAY 29 2018
This assessment expires 120 days after the date it was issued. Date