Form ID

Publication date

Location of premises

Certificate

Office Buildout

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
London Life Insurance Company
Address of Owner
100 Osborne Street North, Winnipeg, Manitoba R3C 3A5
Name of Contractor
Advance Interior Contracting
Address of Contractor
232 Drive In Road, Sault Ste. Marie, ON P6B 6A9
Name of Certifier
London Life Insurance Company
Address of Certifier
100 Osborne Street North, Winnipeg, Manitoba

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

London Life Insurance Company