Form ID

Publication date

Location of premises

Certificate

Underground Site Services

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ironstone Building Company Inc.
Address of Owner
Unit 1-320 Dundas St., London
Name of Contractor
J-AAR Excavating Ltd.
Address of Contractor
3003 Page St., London, ON
Name of Certifier
David Stimal, President Ironstone Building Company
Address of Certifier
320 Dundas St. Unit #1, London, ON

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

Same as Address