Form ID

Publication date

Location of premises

Certificate

General Mechancal/Electrical Revisions

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in right of Ontario as represented by the Chair of the Management Board of Cabinet
Address of Owner
Area Manager, Ontario Realty Corporation, 199 Larch Street,
Name of Contractor
Capital Construction Northern Inc.
Address of Contractor
1260 Kelly Lake Road, Unit 2, Sudbury, ON P3E 5P4
Name of Certifier
Piotrowski Consultants Ltd.
Address of Certifier
1820 Bond Street, North Bay, ON P1B 4V6

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, ON M7A 1N3