Form ID

Publication date

Location of premises

Certificate

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
3075 Maple Grove Road, Bowmanville, ON L1C 6N2
Name of Certifier
Anthony Ambra, Director, Engineering Services
Address of Certifier
As above

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

Owner at above address