Form ID

Publication date

Location of premises

Certificate

Project No. W47000, Upgrade Roof - 162 Agnes St., Pembroke, ON

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty The Queen in right of Ontario as represented by the
Address of Owner
Project Management Branch, Ontario Realty Corporation, 14 Ga
Name of Contractor
Irvcon Limited
Address of Contractor
1145 Pembroke St. E., Pembroke, ON K8A 7R4
Name of Certifier
CSA Consulting Group Ltd.
Address of Certifier
1559 Laperriere Ave., Ottawa, ON K1Z 7T1

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

Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley Street West, 11th Floor, Ferguson Block, Queens Park, Toronto, Ontario M7A 1N3