Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the Township of St. Clair
Address of Owner
1155 Emily Street, Mooretown, ON N0N 1M0
Name of Contractor
K & L Construction (Ontario) Ltd.
Address of Contractor
27-1615 North Routledge Park, London, ON N6H 5N5
Name of Certifier
Paul daSilva, CET Coordinator of Engineering
Address of Certifier
Same as Owner

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

Clerk's Office, Attention: Mr. Jeff Baranek, Township of St. Clair, 1155 Emily Street, Mooretown, ON, N0N 1M0