Form ID

Publication date

Location of premises

Certificate

Installation of municipal services (ie. storm & sanitary sewers, watermains and roadways

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1315578 Ontario Inc.
Address of Owner
4878 Ontario Street, Beamsville, ON L0R 1B3
Name of Contractor
V. Gibbons Contracting Ltd.
Address of Contractor
PO Box 40, 1807 Stevensville Road Stevensville, ON L0S 1N0
Name of Certifier
Upper Canada Planning & Engineering Ltd.
Address of Certifier
215 Ontario Street, St. Catharines, ON L2R 5L2

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

215 Ontario Street, St. Catharines, ON L2R 5L2