Form ID

Publication date

Location of premises

Certificate

Street Light Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of Uxbridge
Address of Owner
51 Toronto St. S., Uxbridge, ON L9P 1T1
Name of Contractor
Langley Utilities Contracting
Address of Contractor
71 Mearns Court, Unit 220, Bowmanville, ON L1C 4N4
Name of Certifier
Lukas Gillham
Address of Certifier
same as owner

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

51 Toronto St. S., Uxbridge, ON L9P 1T1 Attn: Debbie Leroux