Form ID

Publication date

Location of premises

Certificate

Storm Sewer Outlet

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Norfolk County
Address of Owner
183 Main Street, Delhi, ON N4B 2M3
Name of Contractor
Tri-Con Excavating Inc.
Address of Contractor
894 Railton Ave., London, ON N5V 4V9
Name of Certifier
G. Douglas Vallee Limited
Address of Certifier
51 Park Road, R.R. #1, Simcoe, ON N3Y 4J9

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

183 Main Street, Delhi, ON N4B 2M3