Form ID

Publication date

Location of premises

Certificate

Contract No. 01-05 Supply and Placement of Hot Mixed, Hot Laid Asphaltic Concrete Paving

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Town of Penetanguishene
Address of Owner
P.O. Box 5009, Penetanguishene, ON L9M 2G2
Name of Contractor
K.J. Beamish Construction Co. Ltd.
Address of Contractor
P.O. Box 2177, Orillia, ON L3V 6S1
Name of Certifier
H. Borgdorff, P. Eng., Town Engineer
Address of Certifier
Same as owner

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

Town of Penetanguishene, P.O. Box 5009, Penetanguishene, Ontario L9M 2G2