Form ID

Publication date

Location of premises

Certificate

Construct Roads to base course asphalt on the above streets

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
KNL Developments Inc.
Address of Owner
c/o Urbandale Corporation, 2193 Arch Street, Ottawa, ON K1G
Name of Contractor
Karson Kartage and Konstruction (1994) Limited
Address of Contractor
3725 Carp Road, PO Box 264, Carp, ON K0A 1L0
Name of Certifier
Cumming Cockburn Limited
Address of Certifier
1770 Woodward Drive, Ottawa, ON K2C 0P8

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

KNL Developments Inc. c/o Urbandale Corporation, 2193 Arch Street, Ottawa, ON K1G 2H5 Attention