Form ID

Publication date

Location of premises

Certificate

Shane Meadows Subdivision, Underground Services (Except for the Granular "A" and Base Course Asphalt)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
John Corvinelli Investments Ltd.
Address of Owner
24 Dentrex Road, Russell, ON K4R 1A7
Name of Contractor
Collauti Construction Ltd.
Address of Contractor
R.R. #5, Box 908, 2562 Delzotto Avenue, Ottawa (Gloucester),
Name of Certifier
ATREL Engineering Ltd.
Address of Certifier
380 Laurier St., Rockland, ON K4K 1G2

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

John Corvinelli Investments Ltd.