Form ID

Publication date

Location of premises

Certificate

Underground Servicing and Surface Works.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County Contracting of Wheatley Incorporated/Town of Tillsonburg.
Address of Owner
160 Carnegie Street, Ingersoll, ON N5C 4A8/200 Broadway, Sui
Name of Contractor
Classic Excavating Inc.
Address of Contractor
1752 Donnybrook Drive, Dorchester, ON N0L 1G5.
Name of Certifier
Development Engineering (London) Limited.
Address of Certifier
361 Dufferin Avenue, London, ON N6B 1Z5.

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

Addresses as above.