Form ID

Publication date

Location of premises

Certificate

Storm sewer installation

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Township of West Lincoln
Address of Owner
318 Canborough Street, P.O. Box 400, Smithville, ON L0R 2A0
Name of Contractor
Catalina Excavating Inc.
Address of Contractor
913 Mud Street East, Stoney Creek, ON L8J 3C1
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner Address as Above