Form ID

Publication date

Location of premises

Certificate

Supply and Install new carpet tile and vinyl base on the 2nd floor

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Hantom Holdings Inc.
Address of Owner
2193 Arch Street, Ottawa, ON K1G 2H5
Name of Contractor
Adelphia Floor Services Ltd.
Address of Contractor
110 Bentley Avenue, Unit 26, Ottawa, ON K2E 6T9
Name of Certifier
Terry Nichols, President
Address of Certifier
2193 Arch St, Ottawa, ON K1G 2H5

Identification of Premises

Hantom Holdings Inc., 100 Metcalfe Street, Ottawa, ON K1P 5M1

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

Hantom Holdings Inc., 2193 Arch Street, Ottawa, ON K1G 2H5