Form ID

Publication date

Location of premises

Certificate

Project #: R40011 (Upgrade to Public Washrooms)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty the Queen in right of Ontario as represented by the
Address of Owner
Vice President, Project Management Branch, Ontario Realty Co
Name of Contractor
Surrey Construction
Address of Contractor
90 Northline Road Unit 2, Toronto, O M4B 3E5
Name of Certifier
Paul Quiterio - Architect
Address of Certifier
67 Lombard Street, Toronto, ON M5C 1M2

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

President and Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley Street West, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 2G3