Form ID

Publication date

Location of premises

Certificate

Shingled Roof Renewal

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
YCC #38
Address of Owner
1135 Leslie Street, Toronto, ON
Name of Contractor
956542 Ontario Ltd. o/a Jack Atlas Roofing
Address of Contractor
450 Bowes Rd., Unit #14, Concord, ON L4K 1K3
Name of Certifier
Grant Managmenet c.o.b. of YCC 38
Address of Certifier
1135 Leslie Street

Identification of Premises

Block A, Plan M-1300 - Borough of Scarborough

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

Grants Management, 1135 Leslie St., Don Mills, ON M3C 2K7