Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of Leeds and the Thousand Islands
Address of Owner
1233 Prince Street, P.O. Box 280, Lansdowne, ON K0E 1L0
Name of Contractor
Jacques Daoust Coating Management Inc.
Address of Contractor
32 McKenzie Street, Cambridge, ON N1R 4E1
Name of Certifier
Ontario Clean Water Agency
Address of Certifier
Sheridan Centre, 2225 Erin Mills Pkwy, Suite 1200, Mississauga, ON L5K 1T9

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

Adam Goheen, Director of Operations, Township of Leeds and the Thousand Islands, 1233 Prince Street, P.O. Box 280, Lansdowne, ON K0E 1L0