Form ID

Publication date

Location of premises

Certificate

Structural repairs and re-roofing

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of Haldimand County
Address of Owner
45 Munsee St. N., Cayuga, ON N0A 1E0
Name of Contractor
Lancing Construction a division of 651272 Ontario Inc.
Address of Contractor
100 Lancing Drive, Unit #5, Hamilton, ON L8W 3L6
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

Identification of Premises

45 Munsee Street North, Cayuga, Ontario

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

Owner - Address as Above
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