Form ID

Publication date

Location of premises

Certificate

Contract No. OP-02-018 Highway Crack Sealing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
Caledonia Satellite Office, 1 Greendale Drive, Unit #2, Cale
Name of Contractor
788893 Ontario Limited o/a Niagara Crack Sealing
Address of Contractor
6254 Gore St., Niagara Falls ON L2J 4G5
Name of Certifier
Lloyd Rollinson
Address of Certifier
As owner

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

Corporation of Haldimand County, Clerks Department, 95 Munsee St., Cayuga, ON N0A 1E0