Form ID

Publication date

Location of premises

Certificate

Roof Repairs

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty The Queen in right of Ontario as represented by the Chair of the Management Board of Cabinet
Address of Owner
Project Manager, SNC-Lavalin Profac Inc., 304 The East Mall,
Name of Contractor
Schreiber Brothers Limited
Address of Contractor
50 Brockley Dr., Hamilton, ON L8E 3P1
Name of Certifier
Jonathon Rose
Address of Certifier
One Stone Road West, Guelph, ON N1G 4Y2

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

Director of Legal Services, Ontario Realty Corporation, Ferguson Block, Queens Park, Toronto, ON M7A 1N3