Form ID

Publication date

Location of premises

Certificate

Contract No. 17601 Roadworks, Streetlighting, Sanitary Sewer, Watermain and Appurtenances

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Mr. B. Larkin
Address of Owner
PO Box 279, Port Carling, ON P0B 1J0
Name of Contractor
Fowler Construction Company Limited.
Address of Contractor
P.O. Box 630, 1206 Rosewarne Drive, Bracebridge, ON P1L 1T9
Name of Certifier
Totten Sims Hubicki Associates (1997) Limited
Address of Certifier
49-1 Manitoba Street, Bracebridge, ON P1L 2A9

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

PO Box 279, Port Carling, ON P0B 1J0