Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Township of Osgoode
Address of Owner
8243 Victoria St., PO Box 130, Metcalfe, ON K0A 2P0
Name of Contractor
Dibblee Paving & Materials Limited.
Address of Contractor
P.O. Box 11068, Nepean, ON K2H 7T5
Name of Certifier
Kostuch Engineering Limited
Address of Certifier
214-1725 St. Laurent Blvd., Ottawa, ON K1G 3V4

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

The Township of Osgoode, 8243 Victoria St., PO Box 130, Metcalfe, ON K0A 2P0 Attention