Form ID

Publication date

Location of premises

Certificate

Contract 05-03, 2005 Surface Treatment Program

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Lennox and Addington
Address of Owner
97 Thomas Street East, Postal Bag 1000, Napanee, ON K7R 3S9
Name of Contractor
Greenwood Paving (Pembroke) Ltd.
Address of Contractor
1495 Pembroke Street West, Pembroke, ON K8A 7A5
Name of Certifier
Steve Roberts, Manager, Roads and Bridges
Address of Certifier
as address for service above

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

County of Lennox and Addington, as adress for service above, Attention