Form ID

Publication date

Location of premises

Certificate

Contract 08-04 - Crack Sealing Various County Roads

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Lennox and Addington
Address of Owner
97 Thomas Street East, Napanee, ON
Name of Contractor
Roadlast 2000 Inc.
Address of Contractor
7 Industrial Avenue, South Gower Business Park, Kemptville,
Name of Certifier
Darrel Lott
Address of Certifier
same as owner

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

as listed above