Form ID

Publication date

Location of premises

Certificate

Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
1162 Kohler Road, R.R. #3, Cayuga, ON N0A 1E0
Name of Contractor
Norjohn Contracting Limited
Address of Contractor
2800 Townline Road PO Box 100, Thorold, ON L2V 3Y8
Name of Certifier
Phillip Taylor C. Tech
Address of Certifier
as owner

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

Corporation of Haldimand County, Clerks Department 45 Munsee Street Cayuga, ON N0A 1E0