Form ID

Publication date

Location of premises

Certificate

Contract No. O 04-04 for the placement of surface treatment and the application of slurry seal at the following location: Harmony Road North (Winchester R E to Columbus Rd E) Stevenson Road (Raglan Rd W to 600m N/of Raglan Rd W) Coates Road (West City Limits to Simcoe St N)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Oshawa
Address of Owner
50 Centre Street South, Oshawa, ON L1H 3Z7
Name of Contractor
Miller Paving Limited
Address of Contractor
287 Ram Forest Road, Gormley, ON L0H 1G0
Name of Certifier
M.J. Sims, P.Eng.
Address of Certifier
As above

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

Owner at above address