Form ID

Publication date

Location of premises

Certificate

Supply & Lay Hot Mix Asphalt

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of London
Address of Owner
P.O. Box 5035, London ON N6A 4L9
Name of Contractor
TCG Asphalt & Construction Inc.
Address of Contractor
PO Box 189, 2200 Jetstream Road, London, ON N6A 4V7
Name of Certifier
Rick Pedlow
Address of Certifier
P.O. Box 5035, London ON N6A 4L9

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

City Clerks Department, c/o Corporation of the City of London