Form ID

Publication date

Location of premises

Certificate

No. 1 Sideroad culvert replacement, Contract 99-11.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Burlington.
Address of Owner
426 Brant Street, P.O. Box 5013, Burlington, ON L7R 3Z6.
Name of Contractor
Geo. Barnes & Sons Ltd.
Address of Contractor
RR 2, Lowbanks, ON N0A 1K0.
Name of Certifier
Ken Pilatzke, Project Leader, Design and Construction.
Address of Certifier
As owner.

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

Owner - Address as above.