Form ID

Publication date

Location of premises

Certificate

Formwork, Placing of Reinforcing Steel, Pouring and Finishing Concrete

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1353464 Ontario Inc.
Address of Owner
25 Centurian Drive, Suite 201, Markham, Ont. L3R 5N8.
Name of Contractor
D&R Concrete Forming Ltd.
Address of Contractor
4001 Weston Rd., Weston, ON. M9L 2S8.

Identification of Premises

Lots 11, 12, 13, 14 & 15, plan 22A

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

25 Centurian Drive, Suite 201, Markham, ON L3R 5N8