Form ID

Publication date

Location of premises

Certificate

Contract#: Community Roads Resurfacing Project

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Seine River First Nation as represented by PHA Engineering Ltd.
Address of Owner
Seine River First Nation, Box 124 Mine Centre, ON P0W 1H0
Name of Contractor
Tom Veert Contracting Ltd.
Address of Contractor
801 Eight St. West, Box 417, Fort Frances, ON P9A 3M7

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

Seine River First Nation, Box 124 Mine Centre, ON P0W 1H0