Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Regional Municipality of Durham
Address of Owner
Box 623, 605 Rossland Road East, Whitby, ON L1N 6A3
Name of Contractor
Coco Paving Inc.
Address of Contractor
3075 Maple Grove Road, Bowmanville, ON L1C 6N2
Name of Certifier
R. Jagannathan, M.B.A., P. Eng. Director, Transportation and Field Services
Address of Certifier
Regional Municipality of Durham, Box 623, 605 Rossland Road East, Whitby, ON L1N 6A3

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

Owner at above address