Form ID

Publication date

Location of premises

Certificate

Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the County of Essex, Office of the County Engineer.
Address of Owner
360 Fairview Ave. West, Essex, Ont. N8M 1Y6.
Name of Contractor
Shepley Road Maintenance Ltd.
Address of Contractor
2964 County Road #12, RR #2, Essex, ON N8M 2X6
Name of Certifier
Stuart A. Kelch, P. Eng., County Engineer.
Address of Certifier
360 Fairview Ave. West, Essex, Ont. N8M 1Y6.

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

Corporation of the County of Essex, 360 Fairview Ave. West, Essex, Ont. N8M 1Y6.