Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the City of Windsor
Address of Owner
350 City Hall Sq. W., Windsor, ON N9A 6S1
Name of Contractor
Coco Paving (1990) Inc.
Address of Contractor
6725 South Service Road, R.R. #2, Windsor, ON N8N 2M1

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

The Corporation of the City of Windsor, Attention