Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1037196 Ontario Ltd.
Address of Owner
9 Armstrong Street, Leamington, ON N8H 3V2
Name of Contractor
Coco Paving (1990) Inc.
Address of Contractor
6725 South Service Road, R.R. #2, Windsor, Ont. N8N 2M1
Name of Certifier
Bruce D. Crozier Engineering Inc.
Address of Certifier
1940 Deer Run Road, R.R. #4, Leamington, ON N8H 3V7

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

9 Armstrong Street, Leamington, ON N8H 3V2