Form ID

Publication date

Location of premises

Certificate

Clarica Life Insurance 4th Floor new interior construction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Clarica Insurance Company c/o John Robus
Address of Owner
227 King Street South, Waterloo, ON N2J 4C5
Name of Contractor
PCL Constructors, Constructors Canada Inc. Att: Jason Smith
Address of Contractor
57 Auriga Drive, Suite 100, Ottawa, ON K2E 8B2
Name of Certifier
Rice Brydone Limited
Address of Certifier
553 Richmond Street West, Toronto, ON M5V 1Y6

Identification of Premises

Lots 1 to 14 inclusive, Part Lots 15 to 18 inclusive, Registered Plan 146, City of Ottawa (P.I.N. 04 102-0132)

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

Clarica Life Insurance Company, Attention John Robus, 227 King Street South, PO Box 1601 STN Waterloo, ON N2J 4C5