Form ID

Publication date

Location of premises

Certificate

Contract No.: RO 10-013 Hot Mix Padding

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
Roads Operations Division, 1162 Kohler Road, Cayuga, ON N0A
Name of Contractor
Cayuga Asphalt
Address of Contractor
4219 Hwy. 3, Cayuga, ON
Name of Certifier
Danielle Mataseje
Address of Certifier
Corporation of Haldimand County

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

Corporation of Haldimand County, Clerk's Department, 45 Munsee Street, Cayuga, Ontario N0A 1E0