Form ID

Publication date

Location of premises

Certificate

Fisherville Bridge Rehabilitation

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
1 Grendale Dr., Unit 2, Caledonia, ON N3W 2N5
Name of Contractor
W.G. Kelly Construction
Address of Contractor
R.R, #1, P.O. Box 640, Mitchell, ON N0K 1N0
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as above