Form ID

Publication date

Location of premises

Certificate

Baldwin Street Reconstruction, Contract 00-03

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Burlington.
Address of Owner
426 Brant St., Burlington, ON L7R 3Z6.
Name of Contractor
King Paving & Materials Company.
Address of Contractor
3385 Harvester Road, Box 699, Burlington, Ont. L7R 3Y5.
Name of Certifier
Bob Jurk C.E.T.
Address of Certifier
As Owner.

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

As owner.