Form ID

Publication date

Location of premises

Certificate

Roof Upgrade Project ORC Project No. H53614

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty the Queen in right of Ontario as represented by the
Address of Owner
Vice President, Project Management Branch, Ontario Realty Co
Name of Contractor
Racco Industrial Roofing
Address of Contractor
710 Norah Crescent, Thunder Bay, ON P7C 4T8
Name of Certifier
Cook Engineering
Address of Certifier
740 Syndicate Avenue South, Thunder Bay, ON P7E 1E9

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

Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley Street West, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 2G3