Form ID

Publication date

Location of premises

Certificate

Contract No. O 01-10 for the surface treatment and slurry seal of roads in the City of Oshawa at the following location: Thornton Road North (Raglan Rd W to Coates Rd W) Columbus Road East (Ritson Rd N to Grandview St N) Parking Lot @ North Oshawa Arena

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Oshawa
Address of Owner
50 Centre St. S., Oshawa, ON L1H 3Z7
Name of Contractor
Miller Paving Limited
Address of Contractor
287 Ram Forest Road, Gormley, ON L0H 1G0
Name of Certifier
M.J. Sims, P.Eng.
Address of Certifier
As above.

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

Owner at above address