Form ID

Publication date

Location of premises

Certificate

Contract No. O 10-01 For the placement of surface asphalt pavement, concrete curb and gutter and sodding and for the microsurfacing treatment of roads for the resurfacing of roads, including curb and gutter and sidewalk repair

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Oshawa
Address of Owner
50 Centre Street South, Oshawa, ON L1H 3Z7
Name of Contractor
Coco Paving Inc.
Address of Contractor
1255 Wilson Road North, Oshawa, ON L1H 7L3
Name of Certifier
Gary P. Carroll, M. Eng., P. Eng.
Address of Certifier
As above

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

Owner at above address