Form ID

Publication date

Location of premises

Certificate

Road Reconstruction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Town of Milton
Address of Owner
Victoria Park Square, PO Box 1001, Milton, ON L9T 4B6
Name of Contractor
Capital Paving
Address of Contractor
PO Box 815, Guelph, ON N1H 6L8
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as above