Form ID

Publication date

Location of premises

Certificate

Contract 01-01 Henderson Road Reconstruction and Adrian Avenue Rehabilitation

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Burlington
Address of Owner
426 Brant St., Burlington, ON L7R 3Z6
Name of Contractor
King Paving & Materials Company
Address of Contractor
3385 Harvester Road, Box 699, Burlington, ON L7R 3Y5
Name of Certifier
Bob Jurk CET
Address of Certifier
As Owner

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

As owner