Form ID

Publication date

Location of premises

Certificate

Installation of Sound Barrier Job #ETL 99-5017

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Region of Ottawa-Carleton
Address of Owner
111 Lisgar St., Ottawa, ON K2P 2L7
Name of Contractor
N.G.H. Industries Inc.
Address of Contractor
163 Cardevco Rd., R.R. #2, Carp, ON K0A 1L0
Name of Certifier
Bob Singleton
Address of Certifier
R.M.O.C. 111 Lisgar St.

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

Regional Clerk, 111 Lisgar St., Ottawa, ON K2P 2L7