Form ID

Publication date

Location of premises

Certificate

Resurfacing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as Represented by the Minister of Transportation Ontario
Address of Owner
Central Region, 2nd Floor, Atrium Tower, 1201 Wilson Avenue,
Name of Contractor
Miller Paving Limited
Address of Contractor
4615 Thickson Road North, PO Box 520, Brooklin, ON L0B 1C0
Name of Certifier
MTO Contract Control Officer
Address of Certifier
Central Region Construction Office, 2nd Floor, Atrium Tower,

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

Director, Legal Services Office, Main Floor, East Building, 1201 Wilson Avenue, Downsview, ON M3M 1J8