Form ID

Publication date

Location of premises

Certificate

Arthur Pool and Changehouse

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of Wellington North
Address of Owner
7490 Sideroad #7 West, Kenilworth, ON
Name of Contractor
Melloul-Blamey Construction Inc.
Address of Contractor
700 Rupert Street, Unit A, Waterloo, ON N2V 2B5
Name of Certifier
Andrew Bousfield, Architect
Address of Certifier
564 Weber Street N., Unit #5, Waterloo, ON

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

Township of Wellington North, 7490 Sideroad #7 West, Kenilworth, Ontario