Form ID

Publication date

Location of premises

Certificate

Trim Rd. Carpool Lot #15B02-6043.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Ottawa.
Address of Owner
560 Rochester, Ottawa Ont.
Name of Contractor
Cornwall Gravel Co. Ltd.
Address of Contractor
390 Eleventh Street West, Cornwall, ON K6H 5R9
Name of Certifier
Mike Richards.
Address of Certifier
Same.

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

City of Ottawa.