Form ID

Publication date

Location of premises

Certificate

Replace RS 203, 203A and 204 per Fishburn Specification and Drawings dated April 2002

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Grand Erie District School Board
Address of Owner
349 Erie Ave., Brantford, ON N3T 5V3
Name of Contractor
Roque Roofing & Sheet Metal Inc.
Address of Contractor
3 Clark Ave., Hamilton, ON L8L 5J7
Name of Certifier
Fishburn Building Sciences Group Inc.
Address of Certifier
15391 Steeles Ave., Hornby ON L0P 1E0

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

Grand Erie District School Board, 349 Erie Avenue, Brantford, ON N3T 5V3