Form ID

Publication date

Location of premises

Certificate

Culvert Deck Replacements

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of Chatham-Kent
Address of Owner
315 King Street West, Chatham, Ont. N7M 5K8
Name of Contractor
Facca Incorporated
Address of Contractor
747 County Road 31, R.R. #1, Ruscom, ON N0R 1R0
Name of Certifier
Scott Davis, P. Eng., Totten Sims Hubicki Associates Ltd.
Address of Certifier
72 Victoria St. S., Suite 202, Kitchener, ON N2G 4Y9

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

Municipal Clerk, Municipality of Chatham-Kent, 315 King Street West, Chatham, Ont. N7M 5K8