Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the City of Pembroke
Address of Owner
1 Pembroke Street East, Pembroke, ON K8A 3J5
Name of Contractor
R.G.T. Clouthier Construction Ltd.
Address of Contractor
59 Matthews Avenue, Pembroke, ON K8A 0A6
Name of Certifier
McIntosh Perry Consulting Engineers Ltd.
Address of Certifier
115 Walgreen Rd., RR#3, Carp, ON K0A 1L0

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

The City of Pembroke, 1 Pembroke Street East, P.O. Box 277, Pembroke, ON K8A 3J5