Form ID

Publication date

Location of premises

Certificate

Window Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty the Queen in right of Ontario as represented by the
Address of Owner
Vice President, Project Management Branch, Ontario Realty Co
Name of Contractor
Wieger De Jong Construction Ltd.
Address of Contractor
440 West Front St., Stirling, ON K0K 2E0
Name of Certifier
Lisa O’Neil, W.R. White Architect Limited
Address of Certifier
10 Dundas St. W., Belleville, ON K8P 1A1

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

Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley Street West, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 1N3