Form ID

Publication date

Location of premises

Certificate

Labour & Delivery Level 8.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ottawa Hospital - General.
Address of Owner
501 Chemin Smyth Rd., Ottawa, ON K1H 8L6.
Name of Contractor
Massicotte Bros.
Address of Contractor
319 rue Palace Street, Vanier, ON.

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

Owner as above.