Form ID

Publication date

Location of premises

Certificate

Deer Run Subdivision, Highway 21 Left Turn Construction at Jenna Street

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
South Winds Development Co. Inc.
Address of Owner
PO Box 14, Deer Run, R.R. 2, Grand Bend, ON N0M 1T0
Name of Contractor
Lavis Contracting Com. Limited
Address of Contractor
R.R. #2, Clinton, ON N0M 1L0
Name of Certifier
Dillon Consulting Limited per W.A. (Bill) Boussey, P.Eng
Address of Certifier
PO Box 426, London, ON N6A 4W7

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

South Winds Development Co. Inc., PO Box 14, Deer Run, R.R. 2, Grand Bend, ON N0M 1T0 Attention