Form ID

Publication date

Location of premises

Certificate

Site Servicing to Base Asphalt.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Kimshaw Holdings Limited.
Address of Owner
1338 Prince Albert Court, Mississauga, ON L5H 3S1.
Name of Contractor
London Excavators and Trucking Ltd.
Address of Contractor
54 Shaft Road, Etobicoke, ON M9W 4M2.
Name of Certifier
Trafalgar Engineering Ltd.
Address of Certifier
481 Morden Road, Suite #1, Oakville, ON L6K 3W6.

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

Owner.