Form ID

Publication date

Location of premises

Certificate

Subdivision Servicing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Kaiser & Associates
Address of Owner
PO Box 123, 209 Canboro Road, Ridgeville, ON L0S 1M0
Name of Contractor
Alfred Beam Excavating Limited
Address of Contractor
1219 Sunset Drive, Fort Erie, ON L2A 5M4
Name of Certifier
Upper Canada Planning & Engineering
Address of Certifier
3-30 Hannover Drive, St. Catharines, ON L2W 1A3

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

Kaiser & Associates, PO Box 123, 209 Canboro Road, Ridgeville, ON L0S 1M0