Form ID

Publication date

Location of premises

Certificate

Booster Station Installation Known as Project #4521-A

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Municipality of Brockton
Address of Owner
49 Cunningham Road
Name of Contractor
H2 Ontario Water Treatment & Distribution Inc.
Address of Contractor
4009 Perth Road, PO Box 69, Shakespeare, ON N0B 2P0
Name of Certifier
George A. Davis, P.Eng.
Address of Certifier
101 14th Ave., Hanover, ON N4N 3W1

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

Mr. Richard Radford Municipality of Brockton, 100 Scott Street, PO Box 68, Walkerton, ON N0G 2V0