Form ID

Publication date

Location of premises

Certificate

Underground Services and Granulars Known as Project No. 4521

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of Brockton
Address of Owner
100 Scott St., Walkerton, ON N0G 2V0
Name of Contractor
935623 Ontario Ltd. (Moorefield Excavating)
Address of Contractor
R.R. #1, Palmerston, ON N0G 2P0
Name of Certifier
Robert A. Weber, C.E.T.
Address of Certifier
101 11th Avenue, Hanover, ON N4N 3W1

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

Clerk Municipality of Brockton, 100 Scott Street, walkerton, ON N0G 2V0