Form ID

Publication date

Location of premises

Certificate

Double Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the County of Essex, Office of the County Engineer
Address of Owner
360 Fairview Avenue West, Essex, ON N8M 1Y6
Name of Contractor
Shepley Road Maintenance Ltd.
Address of Contractor
2964 County Road 12, Essex, ON N8M 2X6
Name of Certifier
Peter Bziuk, P. Eng., Manager, Design and Construction
Address of Certifier
Corporation of the County of Essex, 360 Fairview Avenue W, Essex, ON N8M 1Y6

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

Attention: Mary Birch Ba, CMO, Director of Council Services/Clerk, Corporation of the County of Essex, 360 Fairview Avenue W., Essex, ON. N8M 1Y6