Form ID

Publication date

Location of premises

Certificate

Contract No. PW-R-04-026 Highway Crack Sealing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of Norfolk County
Address of Owner
183 Main Street, Delhi, ON N4B 2M3
Name of Contractor
788893 Ontario Limited o/a Niagara Crack Sealing
Address of Contractor
40 Stonebridge Drive, Port Colborne, ON L3K 5V4
Name of Certifier
Scott Boughner
Address of Certifier
As owner

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

Mrs. Beverley Wood Clerk/Manager of Council Services, 50 Colborne Street, Simcoe, ON N3Y 4N5