Form ID

Publication date

Location of premises

Certificate

Shouldering, and Ditch Cleanout

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty The Queen in Right of Ontario as represented by the Minister of Transportation
Address of Owner
Ministry of Transportation, 659 Exeter Road, London, ON N6E 1L3
Name of Contractor
Emcon Services Inc.
Address of Contractor
21611 Communication Road, Blenheim, ON N0P 1A0
Name of Certifier
Dave Jessop
Address of Certifier
21611 Communication Road, Blenheim, ON N0P 1A0

Identification of Premises

1121 McFarlane Way Unit 115 Merritt BC V1K 1B9

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

Director, Legal Services Branch, 125 Sir William Hearst Avenue, 1st Floor, Downsview, Ontario M3M 0B5