Form ID

Publication date

Location of premises

Certificate

Road Reconstruction

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
County of Brant
Address of Owner
26 Park Avenue, Burford, ON N0E 1A0
Name of Contractor
Lafarge Paving and Construction
Address of Contractor
595 Oak Park Road, Brantford, ON N3T 5L8
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as Above