Form ID

Publication date

Location of premises

Certificate

Road Reconstruction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of West Lincoln
Address of Owner
318 Canboro Street, P.O. Box 400, Smithville, ON L0R 2A0
Name of Contractor
Rankin Construction Inc.
Address of Contractor
222 Martindale Road, P.O. Box 1116, St. Catharines, ON L2R 7
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as Above