Form ID

Publication date

Location of premises

Certificate

Interior Office Renovation

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
London Life Insurance Company
Address of Owner
100 Osborne Street North
Name of Contractor
Royalty General Construction Ltd.
Address of Contractor
386 Bering Avenue, Etobicoke, ON M8Z 3A9
Name of Certifier
Rose Marie Prall D’Argis
Address of Certifier
100 Osborne Street North, Winnipeg MB R3C 3A5

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

London Life Insurance Company, 100 Osborne Street North, Winnipeg MB R3C 3A5
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