Form ID

Publication date

Location of premises

Certificate

Contract No. 50-00-22 Pulverize Existing Surface Treatment, Crush & Place Granular A & Crush & Stockpile Class II on Hwy 624

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as Represented by the Minister of Transportation
Address of Owner
P.O. Box 1390, New Liskeard, ON P0J 1P0.
Name of Contractor
Bernt Gilbertson Ent. Ltd.
Address of Contractor
R.R. #1, Richards Landing, ON
Name of Certifier
S. McLellan
Address of Certifier
P.O. Box 1390, New Liskeard, ON P0J 1P0

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

Director, Legal Services Office, Main Floor, East Building, 1201 Wilson Avenue, Downsview, ON M3M 1J8.