Form ID

Publication date

Location of premises

Certificate

Asphaltic Overlay on Fourth Line Rd. Etc. Contract No. ISD10-5007

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Ottawa
Address of Owner
City Clerk, City of Ottawa, 110 Laurier Avenue West, Ottawa,
Name of Contractor
Coco Paving Inc.
Address of Contractor
994 Moodie Dr., Ottawa, ON K2R 1H3
Name of Certifier
Steven Forestell
Address of Certifier
Same as Owner

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

City Clerk, City of Ottawa, 110 Laurier Avenue West, Ottawa, ON K1P 1J1