Form ID

Publication date

Location of premises

Certificate

Project 20370 Culvert Reconstruction, Oxford County Road 37

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Oxford
Address of Owner
415 Hunter Street (PO Box 397) Woodstock, ON N4S 4G5 (N4S 7Y
Name of Contractor
Birnam Excavating
Address of Contractor
7046 Nauvoo Road, R.R. #6, Forest, ON N0N 1J0
Name of Certifier
Tony Decoo, C.E.T.
Address of Certifier
P.O. Box 397, Woodstock, ON N4S 7Y3.

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

As above