Form ID

Publication date

Location of premises

Certificate

Paving.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Clarence Rockland.
Address of Owner
1560 Laurier Street, Rockland, Ont. K4K 1P7.
Name of Contractor
Malyon Excavation Ltd.
Address of Contractor
P.O. Box 1614, 17885 South Branch Road, Cornwall, ON K6H 5V6
Name of Certifier
Levac Robichaud Leclerc Associsates Ltd.
Address of Certifier
1-2884 Chamberlain St., Rockland, ON K4K 1M6

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

Provincial Court of Ontario 59 Court Street LOrginal, ON K0B 1K0