Form ID

Publication date

Location of premises

Certificate

Roof Replacement Project # 2004-465054, Contract # 9020

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Her Majesty the Queen in right of Ontario as represented by the Chair of the Management Board of Cabinet
Address of Owner
Project Manager, SNC-LAVALIN PROFAC Inc., 304 The East Mall,
Name of Contractor
Semple Gooder
Address of Contractor
1365 Martin Grove Rd., Toronto, ON M9W 4X7
Name of Certifier
Norm Brown
Address of Certifier
304 The East Mall, Etobicoke, ON M9B 6E2

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

The Chief Executive Officer, Ontario Realty Corporation, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 1N3