Form ID

Publication date

Location of premises

Certificate

Hot Mix Asphalt on parts of Oxford Roads 6 and 46, Contract 291071-HMA2008

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Oxford County
Address of Owner
21 Reeve Street, (P.O. Box 1614) Woodstock, ON N4S 7Y3
Name of Contractor
Walmsley Bros. Ltd.
Address of Contractor
1796 Commissioner Road E., London, ON N6M 1E7
Name of Certifier
Dadean Assam, P. Eng.
Address of Certifier
same as owner

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

as above