Form ID

Publication date

Location of premises

Certificate

Contract I & II - Site Preparation, Storm Drainage Works & Roads to Base Asphalt.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Kamen Hill Estates Inc.
Address of Owner
9196 Finnerty Sideroad, Palgrave, ON L0N 1P0.
Name of Contractor
James Dick Construction Limited.
Address of Contractor
14442 Hwy 50, P.O. Box 470, Bolton, ON L7E 5T4.
Name of Certifier
Aquafor Beech Ltd.
Address of Certifier
2 Marconi Court, Unit 14, Bolton L7E 1E5.

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

Kamen Hill Estates Inc., 9196 Finnerty Sideroad, Palgrave, ON L0N 1P0.