Form ID

Publication date

Location of premises

Certificate

Common Counter.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as Represented by the Chair of Management Board.
Address of Owner
Director, Contract Management Branch, Management Board Secre
Name of Contractor
Moffatt & White Const. Ltd.
Address of Contractor
Box 21064, Stratford, ON.
Name of Certifier
Larry Featherstone, Ontario Realty Corporation.
Address of Certifier
1 Stone Rd. W., Guelph, ON.

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

Director of Legal Services, Management Board Secretariat, Ferguson Block, Queen's Park, Toronto, Ontario M7A 1N3.