Form ID

Publication date

Location of premises

Certificate

Replacement and associated repairs to RSs 201, 202 and 301 as per Fishburn Specification dated March 2004

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
1394482 Ontario Inc.
Address of Owner
295 Phillip Street Waterloo, ON N2L 3W8
Name of Contractor
Dean-Thackeray Roofing Company Ltd.
Address of Contractor
199 Riverbend Drive, Kitchener, ON N2B 2E8
Name of Certifier
Fishburn Building Sciences Group Inc.
Address of Certifier
15391 Steeles Ave., Hornby ON L0P 1E0

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

1394482 Ontario Inc. 295 Phillip Street Waterloo ON N2L 3W8