Form ID

Publication date

Location of premises

Certificate

Office Alterations Project No. X20006

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
K. Knudsen Construction Limited
Address of Contractor
640 Dundas Street East, Belleville, ON K8N 1G7
Name of Certifier
Cybele Ramacciotti
Address of Certifier
South Cottage 14 Gable Lane, Kingston, ON

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 1N3