Form ID

Publication date

Location of premises

Certificate

Hot Mix Resurfacing Job 16B-2004

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the County of Essex, Office of the County Engineer
Address of Owner
360 Fairview Ave. West, Essex, Ont. N8M 1Y6
Name of Contractor
Mill-Am Corporation
Address of Contractor
2155 Fasan Dr., RR #1, Oldcastle, ON N0R 1L0
Name of Certifier
Richard D. Fazecash P.Eng., Assistant County Engineer
Address of Certifier
Corporation of the County of Essex, 360 Fairview Ave. West E

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

Corporation of the County of Essex, 360 Fairview Avenue West, Essex, ON N8M 1Y6