Form ID

Publication date

Location of premises

Certificate

Contract No. ISB03-6042

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Ottawa
Address of Owner
City Clerk, City of Ottawa, 110 Laurier Ave. West, Ottawa, O
Name of Contractor
Dibblee Paving and Materials
Address of Contractor
PO Box 11068, (994 Moodie Drive South) Nepean, ON K2H 7T5
Name of Certifier
M.J. Richards, P.Eng.
Address of Certifier
as owner

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

City Clerk, City of Ottawa, 110 Laurier Ave. W., Ottawa ON K1P 1J1