Form ID

Publication date

Location of premises

Certificate

Repair and Place Sidewalk and Curb and Gutter, Place Top Course Asphalt

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
749902 Ontario Ltd.
Address of Owner
120 King Street West, Suite 1075, Hamilton, ON L8P 4V2
Name of Contractor
All Star Paving Inc.
Address of Contractor
1157 Dowland Crescent, Burlington, ON L7T 4C7
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as above