Form ID

Publication date

Location of premises

Certificate

Curb & gutter, ditch maintenance, shoulder reconstruction and restoration

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the Town of Tillsonburg
Address of Owner
200 Broadway Street, 2nd Floor, Town Center Mall, Tillsonbur
Name of Contractor
TCG Asphalt & Construction Inc.
Address of Contractor
2200 Jetstream Road, PO Box 189, London, ON N6A 4V7
Name of Certifier
Corporation of the Town of Tillsonburg
Address of Certifier
Operations Services, 10 Lisgar Avenue, Tillsonburg, ON N4G 5

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

Corporation of the Town of Tillsonburg, 200 Broadway Street, 2nd Floor, Town Center Mall, Tillsonburg, ON N6G 5A7