Form ID

Publication date

Location of premises

Certificate

Re-Roofing Project No. 01-0136

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Government Building
Address of Owner
900 Highbury Ave., PO Box 5452, London, ON N5Y 1A4
Name of Contractor
990581 Ontario Inc. o/a Summit Roofing & Sheet Metal
Address of Contractor
23 Graham St., Box 1256, Bleheim, ON N0P 1A0
Name of Certifier
Profac Facilities Management for O.R.C.
Address of Certifier
900 Highbury Ave., PO Box 5452, London ON N5Y 1A4

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

Ontario Government Building (ORC c/o Profac Facilities Management ), 870 Richmond Street, Chatham, ON