Form ID

Publication date

Location of premises

Certificate

Hot Mix Asphalt Contract No. M-B-08

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the County of Middlesex
Address of Owner
399 Ridout Street North, London, ON N6A 2P1
Name of Contractor
Walmsley Bros. Ltd.
Address of Contractor
1796 Commissioners Road East, London, ON N6M 1E7
Name of Certifier
Jerry Rychlo, Engineering Supervisor, County Engineer's Office, County of Middlesex
Address of Certifier
399 Ridout Street North, London, ON N6A 2P1

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

Same as Above Owner, Chris Traini, P. Eng. County Engineer