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
Grand Erie DSB
Address of Owner
349 Erie Avenue, Brantford, ON
Name of Contractor
Atlantic Roofers Ontario Ltd.
Address of Contractor
151 Brockley Dr., Unit B, Hamilton, ON
Name of Certifier
Fishburn Building Sciences Group Inc.
Address of Certifier
15391 Steeles Ave., Hornby, ON

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

349 Erie Avenue, Brantford, Ontario
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