Form ID

Publication date

Location of premises

Certificate

Road Reconstruction and Watermain Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of North Middlesex
Address of Owner
P.O. Box 9, Parkhill, ON
Name of Contractor
Lavis Contracting Co. Limited
Address of Contractor
RR #2, Clinton, ON
Name of Certifier
Dillon Consulting Limited
Address of Certifier
495 Richmond Street, London, ON

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

Municipality of North Middlesex, P.O. Box 9, Parkhill, Ontario