Form ID

Publication date

Location of premises

Certificate

Contract No. O 10-11 For the placement of concrete sidewalks and slabs, curb and gutter and For the permanent repair of utility cuts

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Oshawa
Address of Owner
50 Centre Street South, Oshawa, ON L1H 3Z7
Name of Contractor
Olde Thistletown Construction
Address of Contractor
43 Riverdale Drive, Etobicoke, ON M9V 2T4
Name of Certifier
Gary P. Carroll, M.Eng. P.Eng.
Address of Certifier
As above

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

Owner at above address