Form ID

Publication date

Location of premises

Certificate

Sewer Outlet Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Hamilton
Address of Owner
77 James St. N., Hamilton, ON L8R 2K3
Name of Contractor
Elgin Construction
Address of Contractor
140 Burwell Road St. Thomas, ON N5P 3R8
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