Form ID

Publication date

Location of premises

Certificate

Roof Anchors

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Medallion Developments Inc.
Address of Owner
970 Lawrence Avenue West, Suite 304, Toronto, ON M6A 3B6
Name of Contractor
Pro-Bel Group of Companies
Address of Contractor
765 Westney Road South, Ajax, ON L1S 6W1

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

Medallion Developments Inc., 970 Lawrence Avenue West, Suite 304, Toronto, ON M6A 3B6