Form ID

Publication date

Location of premises

Certificate

Lagoon Road Culvert over Cameron Drian

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the Municipality of ChathamKent
Address of Owner
315 King Street West, P.O. Box 640, Chatham, ON N7M 5K8
Name of Contractor
Signature Contractors Windsor Incorporated
Address of Contractor
4255 7th Concession Road, R.R. #1, Windsor, ON N9A 6J3
Name of Certifier
Dillon Consulting Limited
Address of Certifier
202 King Street West, Suite 300, Chatham, ON N7M 1E5

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

Corporaton of the Municipality of Chatham-Kent, P.O. Box 640, 315 King Street West, Chatham, ON N7M 5K8