Form ID

Publication date

Location of premises

Certificate

Contract No. 6250-04-02 Modified Slurry Seal

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the County of Elgin
Address of Owner
450 Sunset Dr., St. Thomas, ON N5R 5V1
Name of Contractor
MSO Construction Limited
Address of Contractor
175 Bethridge Road, Etobicoke, ON M9W 1N4
Name of Certifier
Peter Dutchak, CET
Address of Certifier
As owner

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

Mark G. McDonald, Chief Administrative Officer, County of Elgin, 450 Sunset Drive, St. Thomas, ON N5R 5V1