Form ID

Publication date

Location of premises

Certificate

Contract No. 5057-01-00 Pulverize Crush & Place & Drainage Hwy. 7150 Old Ferguson Highway

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
P.O. Box 1390, New Liskeard, ON P0J 1P0
Name of Contractor
Pedersen Construction Inc.
Address of Contractor
PO Box 2409, New Liskeard, ON P0J 1P0
Name of Certifier
S. McLellan
Address of Certifier
P.O. Box 1390, New Liskeard, ON P0J 1P0

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

Director, Legal Services Office, Main Floor, East Building, 1201 Wilson Avenue, Downsview, ON M3M 1J8