Form ID

Publication date

Location of premises

Certificate

Contract No. 6290-10-06B Elm Street (County Road 53) Culvert Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the County of Elgin
Address of Owner
450 Sunset Drive, St. Thomas, ON N5R 5V1
Name of Contractor
Elgin Construction
Address of Contractor
P O Box 24010, RPO Edward St., St. Thomas, ON N5P 0B5, 140 B
Name of Certifier
Meredith Goodwin, CET, Engineering Technologist
Address of Certifier
Same as Owner

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

Mark G. McDonald, Chief Administrative Officer, County of Elgin, 450 Sunset Drive, St. Thomas, Ontario N5R 5V1