Form ID

Publication date

Location of premises

Certificate

Contract No.: EI 08-033 Hot Mix Urban Overlay

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
Caledonia Satellite Office, 282 Argyle Street South, Caledon
Name of Contractor
Cayuga Materials and Construction Co. Ltd.
Address of Contractor
R.R. #4, Cayuga, ON N0A 1E0
Name of Certifier
Lloyd Rollinson, Supervisor, Engineering Products
Address of Certifier
as owner

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

Corporation of Haldimand County, Clerk's Department, 95 Munsee Street, Cayuga, Ontario N0A 1E0