Form ID

Publication date

Location of premises

Certificate

Asphalt Paving & Concrete Works 10-T20

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the City of Cornwall
Address of Owner
1225 Ontario St., Cornwall, ON
Name of Contractor
Cornwall Gravel Co. Ltd.
Address of Contractor
390 11th St. W., Cornwall, ON K6J 3B2
Name of Certifier
Jamie Fawthrop, Eng.
Address of Certifier
1225 Ontario St., Cornwall, ON

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

City of Cornwall