Form ID

Publication date

Location of premises

Certificate

Belmont Elevated Storage Tank and Related Appurtenances as defined in Contract Documents dated June 2004, Dillon Project No. 04-2949

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of Central Elgin
Address of Owner
450 Sunset Drive, 1st Floor, St. Thomas, ON N5R 5V1
Name of Contractor
Landmark Structures
Address of Contractor
3091 Harrison Court, Burlington, ON L7R 3X4
Name of Certifier
Dillon Consulting Limited per W.A. (Bill) Boussey, P. Eng.
Address of Certifier
P.O. Box 426, London, ON N6A 4W7

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

Municipality of Central Elgin, 450 Sunset Drive, 1st Floor, St. Thomas, Ontario N5R 5V1