Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the Town of Amherstburg
Address of Owner
512 Sandwich Street, South, Amherstburg, ON N9V 3R2
Name of Contractor
Jeff Shepley Excavating Ltd.
Address of Contractor
2964 County Road No. 12, Essex, ON N8M 2X6
Name of Certifier
Hrycay Consulting Engineers Inc.
Address of Certifier
1725 North Talbot Road, Windsor, ON N9A 6J3

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

512 Sandwich Street South, Amherstburg, Ontario N9V 3R2