Form ID

Publication date

Location of premises

Certificate

Office Build Out

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Great-West Life Assurance Company
Address of Owner
Corporate Properties, Dpt. 132, 100 Osborne Street North, Wi
Name of Contractor
Royalty General Construction Ltd.
Address of Contractor
386 Bering Ave., Toronto, ON M8Z 3A9
Name of Certifier
Joann McKillop, Manager, Corporate Properties
Address of Certifier
100 Osborne Street North, Winnipeg, MB R3C 3A5

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

The Great-West Life Assurance Company, 100 Osborne Street North, Winnipeg, MB R3C 3A5