Form ID

Publication date

Location of premises

Certificate

Alteration Fixture/Building/Shell

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Loblaws Inc.
Address of Owner
1 Presidents Choice Circle, Brampton, ON L6Y 5S5
Name of Contractor
Re-Con Retail Construction Inc.
Address of Contractor
1472 Thornton Road North, Unit #4, Oshawa, ON L1H 7K4

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

1020 Islington Avenue, Toronto, ON M8Z 6A4 - Jim's No Frills