Form ID

Publication date

Location of premises

Certificate

Reconstruction of Dover Street, Contract No. PT03-23

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Waterloo
Address of Owner
Parks & Work Services, Waterloo Service Ctr., 265 Lexing
Name of Contractor
Sousa Concrete Ltd.
Address of Contractor
R.R. #1, Branchton, ON N0B 1L0
Name of Certifier
Totten Sims Hubicki Associates
Address of Certifier
72 Victoria Street S., Suite 202, Kitchener, ON N4G 4Y9

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

City of Waterloo, Parks & Work Services, Waterloo Service Ctr., 265 Lexington Court, Waterloo, ON N2J 4A8