Form ID

Publication date

Location of premises

Certificate

Moravian Water Supply Project Phase IV - Water Distribution - Quadrants 1 & 3.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Moravian of the Thames Delaware Nation.
Address of Owner
R R #3, Thamesville, ON N0P 2K0.
Name of Contractor
Nordell Excavating Limited.
Address of Contractor
1311 Lougar Ave., Sarnia, ON N7S 5N5
Name of Certifier
First Nations Engineering Services Ltd.
Address of Certifier
P.O. Box 280, 1786 Chiefswood Road, Ohsweken, ON N0A 1M0.

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

Owner, Address as above.