Form ID

Publication date

Location of premises

Certificate

State Farm Insurance Companies, Kitchener Service Center Remodel, 5 Executive Place, Kitchener, Ont.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
State Farm Insurance Companies.
Address of Owner
100 Consilium Place, Suite 102, Scarborough, ON M1H 3G9.
Name of Contractor
The Prime Corporation.
Address of Contractor
85 Scarsdale Road, Suite 300, North York, ON M3B 2R2.
Name of Certifier
L.E. Glazer Architect Limited.
Address of Certifier
85 Scarsdale Road, Suite 300, North York, ON M3B 2R2

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

State Farm Insurance Companies, (100 Consilium Place, Suite 102, Scarborough, ON M1H 3G9).