Form ID

Publication date

Location of premises

Certificate

Contract #: 2004-5612 Cochrane Area Hwy. 11, Rout and Seal from Smooth Rock Falls W’ly 28.7 km to 2.3 km West of Wellington Creek Bridge New Liskeard Area - Hwy 11 from Temagami S’ly 12.0 kms & Hwy 65 from Elk Lake E’ly 14.3 km

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty The Queen in Right of Ontario as represented by the Minister of Transportation
Address of Owner
500 Rockley Rd., PO Box 1390, New Liskeard, ON P0J 1P0
Name of Contractor
Roadlast 2000 Inc.
Address of Contractor
2644 Leitrim Rd., Ottawa, ON K1T 3V3

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

Director, Legal Services Office, Main Floor, East Building, 1201 Wilson Ave. Downsview ON M3M 1J8