Form ID

Publication date

Location of premises

Certificate

Sidewalk Construction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of West Lincoln
Address of Owner
6218 London Road, Smithville, ON L0R 2A0
Name of Contractor
Pacific Paving
Address of Contractor
5845 Luke Road, Unit #204, Mississauga, ON L4W 2K5
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as above