Form ID

Publication date

Location of premises

Certificate

Reconstruction of Columbia Street, Phase IV, Fischer-Hallman Road to Old Post Road, Project No. PT05-12

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Waterloo
Address of Owner
Service Centre, 265 Lexington Court, Waterloo, ON N2J 4A8
Name of Contractor
410754 Ontario Limited (Sousa Concrete)
Address of Contractor
1430 Branchton Road, Branchton, ON N0B 1L0
Name of Certifier
Totten Sims Hubicki Associates
Address of Certifier
72 Victoria St. S., Suite 202, Kitchener, ON N4G 4Y9

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

The Corporation of the City of Waterloo, 265 Lexington Court, Waterloo, ON N2J 4A8