Form ID

Publication date

Location of premises

Certificate

Road and lot construction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Brantford
Address of Owner
100 Wellington Square, Brantford, ON N3T 2M3
Name of Contractor
Brantford Engineering and Construction Limited
Address of Contractor
54 Ewart Ave., Brantford, ON N3T 5M1
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as Above