Form ID

Publication date

Location of premises

Certificate

Contract No. 9916(H) Part “A” - Shoulder Gravel (County Road 124).

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the County of Simcoe.
Address of Owner
1110 Highway 26, Administration Centre, Midhurst, ON L0L 1X0
Name of Contractor
Georgian Aggregates & Construction Inc.
Address of Contractor
Box 340, Collingwood, Ont. L9Y 3Z7.
Name of Certifier
William H. Brown, P.Eng., County Engineer.
Address of Certifier
1110 Highway 26, Administration Centre, Midhurst, ON L0L 1X0

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

County Clerk, The Corporation of the County of Simcoe, 1110 Highway 26, Administration Centre, Midhurst, ON L0L 1X0.