Form ID

Publication date

Location of premises

Certificate

Project 155-27308 the construction of watermain and appurtenances in the Community of Innerkip in the Township of East Zorra-Tavistock

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Oxford
Address of Owner
415 Hunter St., (P.O. Box 397) Woodstock, ON N4S 4G5 (N4S 7Y
Name of Contractor
A. Van Egmond Construction Ltd.
Address of Contractor
2914 Grimsby Road, PO Box 520, Smithville, ON L0R 2A0
Name of Certifier
Douglas Ellis, P. Eng.
Address of Certifier
Same as owner

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

As Above