Form ID

Publication date

Location of premises

Certificate

Hot Mix Patching HL1 and Granular A Shouldering, Highway 7,

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as Represented by the Minister of Transportation
Address of Owner
50 Monck Street, Box 300, Bancroft, ON K0L 1C0
Name of Contractor
Warren Paving Limited
Address of Contractor
Box 323, Belleville, ON K8N 5A5
Name of Certifier
Robert Robinson Engineering Services Supervisor (A)
Address of Certifier
50 Monck Street, Box 300, Bancroft, ON K0L 1C0

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

Director, Legal Services Office, Main Floor, East Building, 1201 Wilson Avenue, Downsview, ON M3M 1J8