Form ID

Publication date

Location of premises

Certificate

Repairs due to cab fire

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Housing Services Inc.
Address of Owner
35 Carl Hall, Unit #3, Toronto, ON M3K 2B6
Name of Contractor
Quality Allied Elevator
Address of Contractor
80 Citizen Court, Suite 11, Markham, ON L6G 1A7
Name of Certifier
Fadi Harb
Address of Certifier
same as owner

Identification of Premises

Plan 4090 Lot 1, Pt Rd. Closed & Pt Rd. Allowance Closed, Between Con A, B

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

35 Carl Hall, Unit #3, Toronto, Ontario M3K 2B6