Form ID

Publication date

Location of premises

Certificate

Contract # AMC 2011-14 MTO Annual Capital improvement Item Breakdown: Item 1) GWP 4020-13-00 Partial Depth Removal and Hot Mix Asphalt Type B2, 2) GWP 4021-13-00 Centreline Culvert Installation Non-freeway, 3) GWP 402213-00 Entrance Culvert Installation, 4) GWP 4023-13-00 Shouldering, 5) GWP 4024-1300 Ditch Cleanout, 6) GWP 4025-13-00 Tree Cutting, 7) GWP 4026-13-00 Capital Improvements Facilities, 8) GWP 4027-13-00 Capital Improvements Structural, 9) GWP 4028-13-00 Capital Improvements Electrical

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
Ministry of Transportation, 1355 John Counter Boulevard, Kin
Name of Contractor
High Road Maintenance
Address of Contractor
1201 Division St., P.O. Box 24089, Kingslake PO Kingston, ON

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

Director, Legal Services Branch 1st Floor, West Tower, 1201 Wilson Avenue, Downsview, Ontario M3M 1J8