Form ID

Publication date

Location of premises

Certificate

Parking Lot Improvements

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Burlington
Address of Owner
426 Brant Street, PO Box 5013, Burlington, ON L7R 3Z6
Name of Contractor
Pacific Paving
Address of Contractor
5845 Luke Road, Unit 204, Mississauga, ON L4W 2K5
Name of Certifier
Philips Engineering Ltd.
Address of Certifier
3215 North Service Road, Box 220, Burlington, ON L7R 3Y2

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

Owner - Address as above
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