Form ID

Publication date

Location of premises

Certificate

Contract PWR-10-009 for the supply of labour, material and equipment for the application of Crack Sealing on various roads under the jurisdiction of the County of Oxford

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Reeve Street (P.O. Box 1614), Woodstock, ON N4S 3G1
Name of Contractor
Roadmaster Road Construction and Sealing Ltd.
Address of Contractor
200 Pellatt Avenue, Weston, ON M9N 2P6
Name of Certifier
Michael Campbell, M.Sc., P.Eng., Operations Manager
Address of Certifier
Oxford County

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

As above