Form ID

Publication date

Location of premises

Certificate

Contract No.: 199172C The provision of Granular ‘A’ and one life of base hot mix asphalt HL4 at the Alpine Hills Subdivision, Part Lot 21, Conc. 3 Parts 1 & 2 of Reference Plan 16R-7415

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Lifescape Investments Ltd.
Address of Owner
c/o Dr. Frank Gigone 2169 6th Line, Oakville, ON L6H 3X2
Name of Contractor
Arnott Construction Ltd.
Address of Contractor
4 High St., Collingwood, ON L9Y 3J6
Name of Certifier
Henderson, Paddon & Associates Ltd.
Address of Certifier
945 Third Ave. E., Suite 212, Owen Sound, ON N4K 2K8

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

Lifescape Investments Ltd. c/o Dr. Frank Gigone 2169 6th Line, Suite 1, Oakville, ON L6H 3X2