Form ID

Publication date

Location of premises

Certificate

Storm sewers, concrete sidewalk and curb & gutter, asphalt paving, boulevard restoration incl. topsoil and sod/seed

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the Town of Tillsonburg
Address of Owner
200 Broadway St., 2nd Floor, Town Center Mall, Tillsonburg,
Name of Contractor
Amico Infrastructures Inc.
Address of Contractor
1042 Parkinson Road, Woodstock, ON N4S 7W3
Name of Certifier
Corporation of the Town of Tillsonburg
Address of Certifier
Operations Services, 10 Lisgar Avenue, Tillsonburg, ON N4G 5

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

Corporation of the Town of Tillsonburg, 200 Broadway Street, 2nd Floor, Town Center Mall, Tillsonburg, ON N4G 5A7