Form ID

Publication date

Location of premises

Certificate

Brick and Block

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in right of Ontario as represented by the Chair of the Management Board of Cabinet
Address of Owner
Project Manager, Profac Facilities Management Services Inc.,
Name of Contractor
Elgin Contracting and Restoration Ltd.
Address of Contractor
157 Ross Street, St. Thomas, ON N5R 3X9.
Name of Certifier
Howard Crummer
Address of Certifier
900 Highbury St., London, ON

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

The Chief Executive Officer, Ontario Realty Corporation, 11th Floor, Ferguson Block, Queens Park, Toronto, Ontario M7A 1N3