Form ID

Publication date

Location of premises

Certificate

Resurfacing Job 27B-2004

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the County of Essex, Office of the County Engineer
Address of Owner
360 Fairview Ave. West, Essex, Ont. N8M 1Y6
Name of Contractor
Dunn Paving Ltd.
Address of Contractor
R.R. #1, 485 Little Baseline Road, Tecumseh, ON N8N 2L9
Name of Certifier
Richard D. Fazecash P.Eng., Assistant County Engineer
Address of Certifier
Corporation of the County of Essex, 360 Fairview Ave. West E

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

Corporation of the County of Essex, 360 Fairview Avenue West, Essex, ON N8M 1Y6