Form ID

Publication date

Location of premises

Certificate

Description of work as per Fishburn Specification dated October 2005

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Grand Erie District School Board
Address of Owner
349 Erie Ave., Brantford, ON N3T 5V3
Name of Contractor
Semple-Gooder Roofing Limited
Address of Contractor
1365 Martingrove Road, Toronto, ON M9W 4X7
Name of Certifier
Fishburn Building Sciences Group Inc.
Address of Certifier
15391 Steeles Avenue, Hornby, ON L0P 1E0

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

Address