Form ID

Publication date

Location of premises

Certificate

Contract PW-R08-007 for the supply of labour, material and equipment for the application of surface treatment on various roads under the jurisdiction of the County of Oxford, the Town of Tillsonburg and the Townships of Blandford-Blenheim, East Zorra-Tavistock, Norwich and Zorra

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Reeve Street (P.O. Box 1614), Woodstock, ON N4S 3G1
Name of Contractor
Cornell Construction Limited
Address of Contractor
410 Hardy Road, Brantford, ON N3T 5L8
Name of Certifier
Michael Campbell, M.Sc., P. Eng., Operations Manager
Address of Certifier
Oxford County

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

as above