Form ID

Publication date

Location of premises

Certificate

Asphalt resurfacing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Town of Milton
Address of Owner
150 Mary Street, Milton, ON L9T 6Z5
Name of Contractor
C. Valley Paving Ltd.
Address of Contractor
10535 Hwy 50, Kleinburg, ON L0J 1C0
Name of Certifier
Amec Foster Wheeler
Address of Certifier
3450 Harvester Road, Suite 100, Burlington, ON L7N 3W5

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

Owner - Address as Above