Form ID

Publication date

Location of premises

Certificate

Contract No.: RO 10-010 Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
Roads Operations Division, 1162 Kohler Road, Cayuga, ON N0A
Name of Contractor
Norjohn Limited
Address of Contractor
4365 Corporate Drive, Burlington, ON
Name of Certifier
Danielle Mataseje
Address of Certifier
same as owner

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

Corporation of Haldimand County, Clerk's Department, 45 Munsee Street North, Cayuga, Ontario N0A 1E0