Form ID

Publication date

Location of premises

Certificate

Contract No.: PW-R-03-044, Supply and Apply Emulsified Asphalt Slurry Seal Surface - Type II.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of Norfolk County
Address of Owner
50 Colborne Street, Simcoe, ON N3Y 4N5
Name of Contractor
MSO Construction Ltd.
Address of Contractor
175 Bethridge Road, Etobicoke, ON M9W 1N4
Name of Certifier
Scott Boughner
Address of Certifier
Same as owner

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

Mrs. Beverley Wood, Clerk/Manager of Council Services, 50 Colborne Street, Simcoe, ON N3Y 4N5