Form ID

Publication date

Location of premises

Certificate

Contract No. 98-56, Grading, Drainage, Granular Base, Hot Mix Paving, Illumination and Buildings.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as Represented by the Minister of Transportation.
Address of Owner
447 McKeown Avenue, Suite 301, North Bay, ON P1B 9S9.
Name of Contractor
Pedersen Construction Inc.
Address of Contractor
P.O. Box 2409, Hwy 11 & 65 West, New Liskeard, Ont. P0J
Name of Certifier
Ministry of Transporation.
Address of Certifier
447 McKeown Avenue, Suite 301, North Bay, ON P1B 9S9.

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

Ministry of Transporation.