Form ID

Publication date

Location of premises

Certificate

Double Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of Highlands East
Address of Owner
2249 Loop Rd., Box 295, Wilberforce, K0L 3C0
Name of Contractor
Miller Paving Limited
Address of Contractor
P.O. Box 4080, Markham, Industrial Park, P.O.
Name of Certifier
Earl Covert, Road Superintendent
Address of Certifier
Box 295, Wilberforce, ON K0L 3C0

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

Municipality of Highlands East, 2249 Loop Rd., Box 295, Wilberforce, K0L 3C0