Form ID

Publication date

Location of premises

Certificate

Concrete Pavement Repairs L & A #04-07

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Counties of Lennox & Addington
Address of Owner
97 Thomas Street East, Postal Bag 1000, Napanee, ON K7R 3S9
Name of Contractor
H.R. Doornekamp Construction Ltd.
Address of Contractor
588 Scotland Road, R.R. #1, Odessa, ON K0H 2H0
Name of Certifier
J.T. Watson P.Eng.
Address of Certifier
2383 River Road South R.R. #4, Kemptville, ON K0G 1J0

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

County of Lennox & Addington, As above Attn