Form ID

Publication date

Location of premises

Certificate

Burebrook Lateral Storm Sewers Phase 1, ES4431.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of London.
Address of Owner
P.O. Box 5035, 300 Dufferin Ave., London, Ont. N6A 4L9.
Name of Contractor
Omega Contractors
Address of Contractor
4104 Breck Ave., London, ON N6L 1B5
Name of Certifier
Archibald, Gray & McKay Engineering Ltd.
Address of Certifier
553 Southdale Road East, London, Ont. N6E 1A2.

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

City of London, P.O. Box 5035, 300 Dufferin Ave., London, Ont. N6A 4L9.