Form ID

Publication date

Location of premises

Certificate

Asphalt Overlay

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Cambridge
Address of Owner
50 Dickson Street, 3rd Floor, P.O. Box 669, Cambridge, ON N1
Name of Contractor
Steed and Evans Limited
Address of Contractor
P.O. Box 160, St. Clements, ON N0B 2M0
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner Address as Above