Form ID

Publication date

Location of premises

Certificate

Placement of HL3 top asphalt and Misc. concrete repair work

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Dixie Woods Estates Ltd.
Address of Owner
200 Bridgeland Ave., Toronto, ON M6A 1Z4
Name of Contractor
Harnden & King
Address of Contractor
4900 Thickson Rd. North, Brooklin, ON L0B 1C0
Name of Certifier
Sabourin Kimble & Associates Ltd.
Address of Certifier
110 Old Kingston Road, Pickering Village, Ajax, ON L1T 2Z9

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

R.P. 40M-1811