Form ID

Publication date

Location of premises

Certificate

Long Lake #58 First Nation Office Building

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Long Lake #58 First Nation
Address of Owner
207 Otter Road PO Box 609, Longlac, ON P0T 2A0
Name of Contractor
Diamond Builders
Address of Contractor
PO Box 24059, Thunder Bay, ON P7A 8A9
Name of Certifier
Gord Wickham UMA Engineering Ltd.
Address of Certifier
91 Cumberland Street S., 3rd Floor, Thunder Bay, ON P7B 6A7

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

Long Lake #58 First Nation, 207 Otter Road PO Box 609, Longlac, ON P0T 2A0