Form ID

Publication date

Location of premises

Certificate

Subsequent to issuance of partial completion (Dec. 11, 2017), this, the second and final portion, of the supply of all labour, materials, equipment and services necessary for completion of distribution, site and seasonal items of the Work (i.e. water service connections to existing systems, site restoration, topsoil/seeding) except and excluding other deficiencies communicated separately to the Contractor

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Slate Falls Nation
Address of Owner
48 Lakeview Road, Slate Falls, ON P0V 3C0
Name of Contractor
Kingdom Construction Limited
Address of Contractor
3172 Alps Rd, Ayr, ON N0B 1E0
Name of Certifier
Kelly Merke, P.Eng., Keewatin-Aski Consulting Engineers
Address of Certifier
61 Queen Street, Sioux Lookout, ON P8T 1A8

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

Keewatin-Aski Consulting Engineers, 61 Queen Street, Sioux Lookout, ON P8T 1A8