Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the City of St. Thomas
Address of Owner
PO Box 520, City Hall, 545 Talbot Street, St. Thomas, ON N5P 3V7
Name of Contractor
Fortese Concrete Ltd.
Address of Contractor
3681 Homewood Lane, London, ON N6P 1K3
Name of Certifier
Patrick Anckaert, P. Eng.
Address of Certifier
PO Box 520, City Hall, 545 Talbot Street, St. Thomas, ON N5P 3V7

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

Office of the Clerk, P.O. Box 520, City Hall, 545 Talbot Street, St. Thomas, N5P 3V7