Form ID

Publication date

Location of premises

Certificate

Contract No. O 00158 King Street Reconstruction - Phase 5 & 6

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Brockville
Address of Owner
1 King Street West, PO Box 5000, Brockville, ON K6V 7A5
Name of Contractor
Cornwall Gravel Company Limited
Address of Contractor
390 Eleventh Street West, PO Box 67, Cornwall, ON K6H 5R9
Name of Certifier
Genivar Consulting Group Ltd.
Address of Certifier
9 Broad Street, Suite 306, Brockville, ON K6V 6Z4

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

Corporation of the City of Brockville, 1 King Street West, PO Box 5000, Brockville, ON K6V 7A5 Attention