Form ID

Publication date

Location of premises

Certificate

Maple Park Skateboard Facility, Contract 99-14.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Burlington.
Address of Owner
426 Brant St., Burlington, ON
Name of Contractor
A. Cosmos Concrete & Paving Ltd.
Address of Contractor
187 Emerald St. N, Hamilton, ON L8L 5K9
Name of Certifier
Dave Meyer.
Address of Certifier
As owner.

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

Corporation of the City of Burlington.