Form ID

Publication date

Location of premises

Certificate

Project Number: W24000 Contract Number: 176077-05-90216

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in right of Ontario as represented by the Minister of Public Infrastructure Renewal
Address of Owner
Project Manager Craig Butler, SNCLavalin Profac Inc., 234 Co
Name of Contractor
Cruickshank Construction Limited
Address of Contractor
55 Rigney St., Kingston, ON K7K 6Z3
Name of Certifier
Matt Morkem
Address of Certifier
780 Midpark Dr., Suite 201, Kingston, ON K7M 7P6

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

The Chief Executive Officer, Ontario Realty Corporation, 11th Floor, Ferguson Block, Queen's Park, Toronto, ON M7A 1N3