Form ID

Publication date

Location of premises

Certificate

Contract No. PW-E-04-034 Hunt Street and Hwy. #59 Watermain

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of Norfolk County
Address of Owner
183 Main St., Delhi, ON N4B 2M3
Name of Contractor
Robert M. Simon Construction Ltd.
Address of Contractor
PO Box 973, R.R. #1, Waterford, ON N0E 1Y0
Name of Certifier
Marvin Fehrman C.E.T.
Address of Certifier
as owner

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

The Corporation of Norfolk County, 50 Colborne Street South, Simcoe, ON N3Y 4N5