Form ID

Publication date

Location of premises

Certificate

Contract No. 2000-03 Surface Treatment

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the County of Elgin
Address of Owner
450 Sunset Dr., St. Thomas, ON N5R 5V1
Name of Contractor
Cornell Construction Limited.
Address of Contractor
PO Box 785 410 Hardy Road, Brantford, ON N3T 5R7
Name of Certifier
Justin Lawrence P.Eng.
Address of Certifier
as owner.

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

Mark G. McDonald, Chief Administrative Officer, County of Elgin, 450 Sunset Drive, St. Thomas, ON N5R 5V1.