Form ID

Publication date

Location of premises

Certificate

Site Preparation Construction of underground services and roadworks

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
789274 Ontario Inc.
Address of Owner
R.R. #3, Mitchell, ON N0K 1N0
Name of Contractor
Classic Excavating Inc.
Address of Contractor
1752 Donnybrook Drive, Dorchester, ON N0L 1G5
Name of Certifier
Tony Mellegers, CET CST, KMK Consultants Limited
Address of Certifier
220 Advance Blvd., Brampton, ON L6T 4J5

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

Office of the owner