Form ID

Publication date

Location of premises

Certificate

Construction of a new A & W Restaurant

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1378745 Ontario Inc.
Address of Owner
420 Government Rd., Kapuskasing, ON
Name of Contractor
Lachance Construction
Address of Contractor
154 Clear Lake Rd. North, Kapuskasing, ON P5N 2X7
Name of Certifier
GENIVAR
Address of Certifier
834 Mountjoy St. South, P.O. Box 120, Timmins, ON P4N 7C5

Identification of Premises

Lot No. 1 Plan M169C Parcel 4526CC

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

1378745 Ontario Inc., 420 Government Rd., Kapuskasing, ON