Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Brockville
Address of Owner
Victoria Building, 1 King Street West, P.O. Box 5000, Brockville, ON K6V 7A5
Name of Contractor
Pavetech Ottawa Ltd.
Address of Contractor
2489 Del Zotto Ave, Unit 2, Ottawa, ON K1T 3V6
Name of Certifier
Matthew Locke, Supervisor of Transportation
Address of Certifier
Same as Owner

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

Owner