Form ID

Publication date

Location of premises

Certificate

Replacement of Roof Sections 201, 301, 401 and 402 as per Fishburn Specification dated May 2008

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Hamilton Wentworth D.S.B.
Address of Owner
100 Main Street West, Hamilton, ON
Name of Contractor
Atlantic Roofers Ontario Ltd.
Address of Contractor
151 Brockley Drive, Unit B, Hamilton, ON
Name of Certifier
Fishburn Building Sciences Group Inc.
Address of Certifier
15391 Steeles Avenue, Hornby, ON

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

Address