Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the Municipality of Leamington
Address of Owner
111 Erie Street North, Leamington, ON N8H 2Z9
Name of Contractor
Shepley Road Maintenance Ltd.
Address of Contractor
2964 County Road No. 12, Essex, ON N8M 2X6
Name of Certifier
Andy Dowling, Engineering Project Manager
Address of Certifier
Same as Owner

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

The Corporation of the Municipality of Leamington, 111 Erie Street North, Leamington, Ontario N8H 2Z9