Form ID

Publication date

Location of premises

Certificate

Underground Servicing and Granular “B” Subbase.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Jackson Summerside Land Corp./City of London
Address of Owner
1135 Adelaide Street North, London, ON N5Y 2N4/300 Dufferin
Name of Contractor
Classic Excavating Inc.
Address of Contractor
1752 Donnybrook Drive, Dorchester, ON N0L 1G5.
Name of Certifier
Development Engineering (London) Limited.
Address of Certifier
361 Dufferin Avenue, London, ON N6B 1Z5.

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

Address as above.