Form ID

Publication date

Location of premises

Certificate

Install Back Flow Preventors

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in right of Ontario as represented by the Chair of the Management Board of Cabinet
Address of Owner
Project Manager, PROFAC Facilities Management Services Inc.,
Name of Contractor
Blue-Con Inc.
Address of Contractor
1915 Crumlin Side Road, London, ON N5V 3B8
Name of Certifier
W. Richard Irving
Address of Certifier
900 Highbury Ave. N., London, ON N5A 4L6

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

The Chief Executive Officer, Ontario Realty Corporation, 11th Floor, Ferguson Block, Queens Park, Toronto, Ontario M7A 1N3