Form ID

Publication date

Location of premises

Certificate

Pulverization and Hot Mix Paving

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of Uxbridge
Address of Owner
51 Toronto St. S. Uxbridge, ON L9P 1T1
Name of Contractor
IPAC Paving Limited
Address of Contractor
9251 Yonge St., Unit 8-Suite 872 Richmond Hill, ON L4C 9T3
Name of Certifier
Lukas Gillham
Address of Certifier
Same as Owner

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

51 Toronto St. S. Uxbridge, ON L9P 1T1 Attn: Debbie Leroux