Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the City of Pembroke
Address of Owner
1 Pembroke Street East, Pembroke, ON K8A 3J5
Name of Contractor
H&H Construction Inc.
Address of Contractor
49 Portage Rd, Petawawa, ON K8H 2W8
Name of Certifier
McIntosh Perry Consulting Engineers Ltd.
Address of Certifier
115 Walgreen Rd., RR#3, Carp, ON K0A 1L0

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

The City of Pembroke, 1 Pembroke Street East, P.O. Box 277, Pembroke, ON K8A3J5