Form ID

Publication date

Location of premises

Certificate

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Brockville
Address of Owner
Victoria Building, 1 King Street West P.O. Box 5000, Brockville, ON K6V 7A5
Name of Contractor
Knapps Paving and Landscaping
Address of Contractor
3113 Bethel Rd, Brockville, ON K6V 5T2
Name of Certifier
S.E. Allen, C.E.T. Supervisor of Engineering
Address of Certifier
same as owner

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

Owner