Form ID

Publication date

Location of premises

Certificate

Milling and 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
Coco Paving Inc.
Address of Contractor
485 Little Baseline Road, Tecumseh, ON N8N 2L9
Name of Certifier
Peter Bziuk, P.Eng., Manager, Design and Construction
Address of Certifier
Corporation of the County of Essex, 360 Fairview Avenue W, Essex, ON N8M 1Y6

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

Attention: Mary Birch Ba, CMO, Director of Council Services/Clerk Corporation of the County of Essex, 360 Fairview Avenue W., Essex, ON. N8M 1Y6