Form ID

Publication date

Location of premises

Certificate

Hot Mix Resurfacing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the County of Essex, Office of the County Engineer
Address of Owner
360 Fairview Avenue West, Essex, ON N8M 1Y6
Name of Contractor
Mill-Am Corporation
Address of Contractor
2155 Fasan Drive, R.R. #1, Tecusmeh, ON N0R 1L0
Name of Certifier
Richard D. Fazecash, P. Eng., Assistant County Engineer
Address of Certifier
Corporation of the County of Essex, 360 Fairview Ave. West,

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

Corporation of the County of Essex, 360 Fairview Avenue W., Essex, ON N8M 1Y6