Form ID

Publication date

Location of premises

Certificate

Replace Roofing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in right of Ontario as represented by the Chair of the Management Board of Cabinet
Address of Owner
Program Manager, Property Support Services Branch, Ontario R
Name of Contractor
Provost Roofing Ltd.
Address of Contractor
36 Meadow Lane, Timmins, ON P4R 1M7
Name of Certifier
James E. Harney.
Address of Certifier
590 Chippewa Street W., North Bay, ON P1B 9N2

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

Director, Legal Services Branch, Management Board Secretariat, 7 Queens Park Crescent, Room 228, Frost Building South, Queens Park, Toronto, ON M7A 1Z5