Form ID

Publication date

Location of premises

Certificate

Supply and Place Wear Course Asphalt

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
KNL Developments Incorporated
Address of Owner
2193 Arch Street, Ottawa, ON K1G 2H5
Name of Contractor
R.W. Tomlinson Limited
Address of Contractor
5597 Power Road,Gloucester, ON K1G 3N4
Name of Certifier
Cumming Cockburn Limied
Address of Certifier
1770 Woodward Drive, Ottawa, ON K2C 0P8

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

KNL Developments Inc., c/o Urbandale Corporation, 2193 Arch Street, Ottawa, Ontario K1G 2H5, Attention
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