Form ID

Publication date

Location of premises

Certificate

Resurfacing, Contract 00-11

Date substantially performed:

Participants

Name of Certifier
Mr. Frank Vuk
Address of Certifier
As Owner.
Name of Owner
City of Burlington.
Address of Owner
426 Brant St., Burlington, ON L7R 3Z6.
Name of Contractor
King Paving & Materials Company.
Address of Contractor
3385 Harvester Road, Box 699, Burlington, Ont. L7R 3Y5.

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

As owner.