Form ID

Publication date

Location of premises

Certificate

Replacement of the existing structures and all other miscellaneous works including all traffic control for Ferris Road (Contract 00-02)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Hamilton Attention: Mr. Jerry Parisotto Manager Construction Mr. Tony Sergei - Project Manager
Address of Owner
City of Hamilton/ Regional Municipality of Hamilton-Wentwort
Name of Contractor
W.G. Kelly Construction
Address of Contractor
R.R, #1, P.O. Box 640, Mitchell, ON N0K 1N0
Name of Certifier
Karam Albazi P.Eng. - Bridge Engineer c/o McCormick Rankin Corporation
Address of Certifier
2655 North Sheridan Way, Mississauga, ON L5K 2P8

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

As above