Form ID

Publication date

Location of premises

Certificate

Project #: W23001 Upgrade Roof

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty the Queen in right of Ontario as represented by the
Address of Owner
Vice-President Project Management Branch, Ontario Realty Cor
Name of Contractor
ICI Roofing
Address of Contractor
PO Box 238, 709C The Parkway, Peterborough, ON K9J 6Y8
Name of Certifier
Wilcox Architects Inc.
Address of Certifier
74 Linday Street South, Lindsay, ON K9V 2M2

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

President and Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley Street West, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 2G3