Form ID

Publication date

Location of premises

Certificate

Underground Municipal Servicing and Surface Work

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Pacific & Western Bank of Canada
Address of Owner
140 Fullerton St., Suite 2002, London, ON N6A 5P2
Name of Contractor
A-Max Contracting (Division of 748086 Ontario Limited)
Address of Contractor
1163 Crumlin Sideroad, London, ON N5V 1R6
Name of Certifier
Stantec Consulting Ltd.
Address of Certifier
171 Queens Ave., 8th Floor, London, ON N6A 5J7

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

Pacific & Western Bank of Canada, 140 Fullerton St., Suite 2002, London, ON N6A 5P2