Form ID

Publication date

Location of premises

Certificate

Description of work as per Fishburn Specification dated April 2006

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Hamilton Wentworth D.S.B.
Address of Owner
100 Main Street West, Hamilton, ON
Name of Contractor
Roque Roofing Inc.
Address of Contractor
3 Clark Avenue, Hamilton, ON
Name of Certifier
Fishburn Building Science Group Inc.
Address of Certifier
15391 Steeles Avenue, Hornby, ON

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

100 Main Street West, Hamilton, ON
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