Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Haldimand County
Address of Owner
Caledonia Satellite Office, 282 Argyle Street South, Caledonia, ON N3W 1K7
Name of Contractor
Coco Paving Inc.
Address of Contractor
669 Nebo Rd RR 2, Hannon, ON L0R 1P0
Name of Certifier
Lloyd Rollinson, Project Manager, Municipal Infrastructure
Address of Certifier
Same as Owner

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

Corporation of Haldimand County, Clerk's Department, 45 Munsee Street North, Cayuga, Ontario N0A 1E0