Form ID

Publication date

Location of premises

Certificate

Revisions to Existing Storage Chamber

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Joe Synders Construction Ltd.
Address of Owner
R.R. #1, Belmont, ON N0L 1B0
Name of Contractor
Classic Excavating Inc.
Address of Contractor
1752 Donnybrook Drive, Dorchester, ON N0L 1G5.
Name of Certifier
Delcan Corporation
Address of Certifier
1069 Wellington Road South, #214, London, ON N6E 2H6

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

R.R. #1, Belmont, Ontario N0L 1B0