Form ID

Publication date

Location of premises

Certificate

Roof Safety Anchor Installation (Building A and B)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1319399 Ontario Inc.
Address of Owner
c/o Vertica Resident Services Inc., 33 Yonge Street, 10th fl
Name of Contractor
Canadian Safety Anchor Inspections Inc. (CSAI)
Address of Contractor
1472 Thornton Rd. North, Building A - Unit 7, Oshawa, ON L1H
Name of Certifier
Brown & Beattie Ltd.
Address of Certifier
556 Edward Avenue, Unit 71, Richmond Hill, ON L4C 9Y5

Identification of Premises

Part of Lot 13, Concession 1 New Survey (Trafalgar), All of PIN 24962-0076 (LT), 122A & 122B Bronte St., Town of Milton

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

Owner's Address for Service