Form ID

Publication date

Location of premises

Certificate

Contract No. 291002 - 2005 - Pittock Reservoir Bridge Rehabilitation, Oxford County Road 4

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Market Square (P.O. Box 397), Woodstock, ON N4S 7Y3
Name of Contractor
Weathertech Restoration Services Inc.
Address of Contractor
553 Clarke Road, London, ON N5V 2E1
Name of Certifier
Philip Baker, P. Eng., Springbank Consulting Engineers Ltd., Woodstock, Ontario
Address of Certifier
871 Dundas St., Woodstock, ON N4S 1G8

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

as above