Form ID

Publication date

Location of premises

Certificate

Contract No.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in Right of Ontario as represented by the Minister of Transportation
Address of Owner
Box 1390, New Liskeard, ON P0J 1P0
Name of Contractor
Loach Asphalt Ltd.
Address of Contractor
292 Hawn Drive, P.O. Box 998, New Liskeard, ON P0J 1P0

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

Director, Legal Services Office, Main Floor, East Building, 1201 Wilson Avenue, Downsview, ON M3N 1J8