Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Belleville
Address of Owner
169 Front Street, Belleville, ON K8N 2Y8
Name of Contractor
Fitzgibbon Construction Ltd.
Address of Contractor
51 Parks Dr., Belleville, ON K8N 4Z5
Name of Certifier
Jewell Engineering Inc.
Address of Certifier
4 Cataraqui Street, Suite 208, Kingston, ON K7K 1Z7

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

169 Front Street, Belleville, Ontario, K8N 2Y8