Form ID

Publication date

Location of premises

Certificate

Single Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the County of Essex
Address of Owner
Office of the County Engineer, 360 Fairview Ave. West, Essex
Name of Contractor
Shepley Road Maintenance Ltd.
Address of Contractor
2964 County Road #12, RR #2, Essex, ON N8M 2X6
Name of Certifier
Stuart A. Kech, P.Eng. County Engineer
Address of Certifier
360 Fairview Avenue West, Essex, ON N8M 1Y6

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

Coproration of the County of Essex, 360 Fairview Avenue West, Essex, ON N8M 1Y6