Form ID

Publication date

Location of premises

Certificate

Contract No. 291007-2003 rehabilitation of the bridge (33004) over the Thames River on Oxford County Road 33, south of the former Village of Embro in the Township of Zorra

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Oxford.
Address of Owner
415 Hunter Street (P.O. Box 397), Woodstock, ON N4S 4G5 (N4S
Name of Contractor
Triad Contracting A Division of 1375531 Ontario Limited
Address of Contractor
1185 Michener Road, Sarnia, ON N7S 4W3
Name of Certifier
Douglas Ellis, P. Eng., Construction Manager, County of Oxford
Address of Certifier
Same as Owner

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

As above