Form ID

Publication date

Location of premises

Certificate

Contract No.: ENG-2010-07 Surface Treatment on Various Roads

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
The Corporation of the City of Kingston
Address of Owner
216 Ontario Street, Kingston, ON K7L 2Z3
Name of Contractor
Smiths Construction
Address of Contractor
276 Madawaska Blvd., Arnprior, ON K7S 3N4
Name of Certifier
Mark Van Buren, P. Eng.
Address of Certifier
Same as Owner

Identification of Premises

This contract generally includes Surface Treatment on Various Roads

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

On Property Title, Land Registry Office, 1 Court St., Kingston, Ontario K7L 2N4 / City Clerk, Corporation of the City of Kingston, 216 Ontario St., Kingston, Ontario K7L 2Z3