Form ID

Publication date

Location of premises

Certificate

Contract No. O 02-09 for the routing, cleaning and sealing of pavement cracks using hot-poured rubberized bituminous material

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Oshawa
Address of Owner
50 Centre Street South, Oshawa, ON L1H 3Z7
Name of Contractor
Road Savers 2000 Ltd.
Address of Contractor
43 Racine Rd., Rexdale, ON M9W 2Z4
Name of Certifier
M.J. Sims, P. Eng.
Address of Certifier
As above

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

Owner at above address