Form ID

Publication date

Location of premises

Certificate

Contract #: 2004-5629 Rout and seal Hwy. 11

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty The Queen in Right of Ontario as represented by the Minister of Transportation
Address of Owner
Ministry of Transportation, 207 Main St. W., Huntsville, ON
Name of Contractor
Roadlast 2000
Address of Contractor
2644 Leitrim Rd., Ottawa, ON K1T 3V3

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

Director, Legal Services Branch, 1st Floor, West Tower, 1201 Wilson Ave. Downsview ON M3M 1J8