Form ID

Publication date

Location of premises

Certificate

Generator Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Four Counties Health Services
Address of Owner
1824 Concession Dr. Newbury, ON N0L 1Z0
Name of Contractor
ClarkHaasen Electric
Address of Contractor
51 Second St., Unit A, Strathroy, ON N7G 3H8
Name of Certifier
Chorley + Bisset Ltd.
Address of Certifier
2B-369 York Street, London, ON N6B 3R4

Identification of Premises

1824 Concession Dr., Newbury, ON N0L 1Z0

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

Four Counties Health Services