Form ID

Publication date

Location of premises

Certificate

Office Build Out

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
London Life Insurance Company
Address of Owner
100 Osborne Street North, Winnipeg, Manitoba R3C 3A5
Name of Contractor
Smith Brothers Contracting Corp.
Address of Contractor
1353 Sandhill Drive, Ancaster, ON L9G 4V5

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

1353 Sandhill Dr., Ancaster, ON L9G 4V5