Form ID

Publication date

Location of premises

Certificate

Interior Alterations - Office Space Fit Up

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty The Queen in right of Ontario as represented by the
Address of Owner
Vice President, Project Services Branch, 1 Dundas Street Wes
Name of Contractor
Cambria Construction Management
Address of Contractor
1260 Journey's End Circle, Unit 4, Newmarket, ON L3Y 8Z7
Name of Certifier
KBH Interior Design Inc.
Address of Certifier
225 Richmond St. West, Suite 201, Toronto, ON M5V 1W2

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

Chief Executive Officer, Ontario Realty Corporation, 1 Dundas Street West, Suite 2000, Toronto, Ontario M5G 2L5