O. Reg. 174/11: GENERAL

………………………………………………………………………………………………………………

(County/District or Regional Municipality/City or Borough of Municipality of
Metropolitan Toronto in which premises are situate)

………………………………………………………………………………………………………………

(street address and city, town, etc., or, if there is no street address, the location of the premises)

This is to certify that the contract for the following improvement:

………………………………………………………………………………………………………………

(short description of the improvement)

to the above premises was substantially performed on ………………………………………………….…

(date substantially performed)

Date certificate signed: …………………………………..............................................................................

........................................................................................................................................................................

(payment certifier where there is one)

........................................................................................................................................................................

(owner and contractor, where there is no payment certifier)

Name of owner: ……………………………………………………………………………………………..

Address for service: ………………………………………………………………………………………....

Name of contractor: …………………………………………………………………………………………

Address for service: …………………………………………………………………………………………

Name of payment certifier: ………………………………………………………………………………….

(where applicable)

Address: ……………………………………………………………………………………………………..

(Use A or B whichever is appropriate)

A.

Identification of premises for preservation of liens:

……………………………………………………………………………………………………...

(where liens attach to premises, reference to lot and plan number or instrument
registration number)

B.

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

…………………………………………………………………………………………………..…

(where liens do not attach to premises)

This is to certify the completion of a subcontract for the supply of services or materials between ..................

.............................................................................................................................................................................

(name of subcontractor)

and ……………………….………… dated the …………….…..day of ……………..…………… , 20……..

The subcontract provided for the supply of the following services or materials ................................................

…..........................................................................................................................................................................

to the following improvement:

……………………………………………………….....................................................………........................

(short description of the improvement)

of premises at

……………………………………………………….....................................................……….........................

(street address, or if there is none, the location of the premises)

Date of certification …………………………………..............………………………………………………..

.............................................................................................................................................................................

(payment certifier where there is one)

..............................................................................................................................................................................

(owner and contractor)

Name of owner: ………………………………………………………………………………………………..

Address for service: ……………………………………………………………………………………………

Name of contractor: ……………………………………………………………………………………………

Address for service: ……………………………………………………………………………………………

Name of payment certifier (where applicable): ……………………………………………………………….

Address: ……………………………………………………………………………………………………….

(Use A or B whichever is appropriate)

A.

Identification of premises for preservation of liens:

……………………………………………………………………………………………………...

(where liens attach to premises, reference to lot and plan number or
instrument registration number)

B.

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

…………………………………………………………………………………………………..…

(where liens do not attach to premises)

TO: ………………………………………………………………………………………………………...........

(a person named in the claim for lien as having an interest in the premises, the contractor or
the payer of the lien claimant or the solicitor of any of the foregoing.)

This is notice that ……………………………………………………………………………………................ ,

(name of lien claimant, agent or assignee of lien claimant or
trustee of the workers’ trust fund)

a person who is liable to be cross-examined on the claim for lien in respect of an improvement to the following
premises:

…………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

(street address of premises)

will be cross-examined regarding that claim on ..……….………….. , …………………… , at ……………… ,

(date)

(time)

at the office of ........................................................................................................................................................

(name, address and telephone number of examiner)

You are entitled to be present at the cross-examination either personally or by counsel and to participate in the
cross-examination.  Only one cross-examination may be held in respect of this claim for lien.

Date: …………………………………….....................................………………………………………...............

……………………………………………….........................................................................................................

……………………………………………….........................................................................................................

(name, address and telephone number of person or solicitor requiring cross-examination)

TO: ………………………………………………………….......................................………….…………… ,

(name of lien claimant, agent or assignee of lien claimant or trustee of the workers’ trust fund)

a person who is liable to be cross-examined on a claim for lien dated ……………………………............
with respect to the following premises:

……………………………………………………………………………………………………………….....

(street address of premises)

YOU ARE REQUIRED TO ATTEND TO BE CROSS-EXAMINED ON OATH respecting the claim for lien on

……….…………….. , ………………………… , at …………………… , at the office of .............................

(date)

(time)

..............................................................................................................................................................................

(name, address and telephone number of examiner)

and to bring with you all documents relating to the claim.

If you fail, without due cause, to attend your lien may be discharged or you may be liable for any legal costs
arising from your non-attendance.

Date: ……………………………………………………………………………………………………..............

………………………………………………........................................................................................................

………………………………………………........................................................................................................

(name, address and telephone number of person or solicitor requiring cross-examination)

Name of declarant: …………………………………………………………………………………………….…

Address for service: ………………………………………………………………………………………...........

Concise overview of the land (include reference to the lot and plan number and the parcel number(s)):

………………........................................................................................................................................................

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

(Complete for each contractor who supplied services or materials to an improvement during the 90-day period
preceding the date on which the description is to be submitted for approval under subsection 9 (3) of the
Condominium Act, 1998)

Name of contractor: …………………………………………………………………………………………........

Address: ………………………………………………………………………………………………………......

Address for service (if known): ………………………………………………………………………………......

(Add the name, address and address for service of other contractors if applicable)