Form ID

Publication date

Location of premises

Certificate

Contract No. O 01-04 for the construction of granular base course, asphalt pavement, pre-cast concrete curbs, asphalt sidewalk and sodding at the following location: Terry Fox Park (600 Grandview Street South) Sunnyside Park (McKim Street at Stacey Avenue) Storie Park (Mill Street West of Centre Street South)

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Oshawa
Address of Owner
50 Centre St. S., Oshawa, ON L1H 3Z7
Name of Contractor
Pacific Paving Limited
Address of Contractor
5845 Luke Road, Unit #204, Mississauga, ON L4W 2K5
Name of Certifier
M.J. Sims, P.Eng.
Address of Certifier
As above.

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

Owner at above address