Form ID

Publication date

Location of premises

Certificate

Repairs to Structure No. 10091 on County Road 10.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Wellington.
Address of Owner
County Engineer, County of Wellington Administration Centre,
Name of Contractor
Engineered Concrete Limited.
Address of Contractor
130 Shoemaker Street, Unit 2, Kitchener, Ont. N2E 3G4.
Name of Certifier
McCormick Rankin Corporation.
Address of Certifier
2655 North Sheridan Way, Mississauga, Ontario L5K 2P8.

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

As above.