Form ID

Publication date

Location of premises

Certificate

Watermain Reconstruction on the above referenced streets

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Corporation of the City of Belleville
Address of Owner
169 Front Street, Belleville, ON K8N 2Y8
Name of Contractor
Cobourg Development Services Limited
Address of Contractor
609 William Street, P.O. Box 997, Cobourg, ON K9A 4W4
Name of Certifier
Stan Czyczyro C.E.T.
Address of Certifier
Same as Owner

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

Clerks Department, Corporate Services, 169 Front Street, Belleville, Ontario K8N 2Y8
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