Form ID

Publication date

Location of premises

Certificate

Central Water Supply System.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ministry of Natural Resources.
Address of Owner
Suite 221, 435 S. James St., Thunder Bay, Ont.
Name of Contractor
P.N.I. Contracting Ltd.
Address of Contractor
Box 10003, Thunder Bay, ON P7B 6T6.
Name of Certifier
Glenn Gorrie.
Address of Certifier
P.O., Box 252, Kakabeka Falls, Ont. P0T 1W0.

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

Ministry of Natural Resources.