Form ID

Publication date

Location of premises

Certificate

Tenant Leasehold Improvements.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
LCBO.
Address of Owner
55 Lakeshore Blvd. E., Toronto, Ont.
Name of Contractor
Rutherford Contracting Ltd.
Address of Contractor
27 Cardico Drive, Gormley, ON L0H 1G0.
Name of Certifier
Mole White & Associates Ltd.
Address of Certifier
260 King St. E., Toronto, Ont.

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

Address as above.