Form ID

Publication date

Location of premises

Certificate

Retile and grout of Victoria Pool located at 355 Wellington St. Ingersoll

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the Town of Ingersoll
Address of Owner
355 Wellington St., Ingersoll
Name of Contractor
Acapulco Pools
Address of Contractor
1550 Victoria St. North, Kitchener, ON N2B 3E2
Name of Certifier
Aqua Plans Aquatic Consultants
Address of Certifier
1244 Victoria St. N., Unit J, Kitchener, ON N2B 3C9

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

Owner as noted above attn