Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Windsor Utilities Commission, Water Division
Address of Owner
787 Ouellette Ave., P.O. Box 1625, Windsor, ON N9A 5T7
Name of Contractor
Smith Contracting
Address of Contractor
5255 County Rd. #42, Tecumseh, ON N8N 2M1
Name of Certifier
Norbert Poggio, P. Eng.
Address of Certifier
The Windsor Utilities Commission, Water Division

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

The Windsor Utilities Commission, Water Division