Form ID

Publication date

Location of premises

Certificate

Excavation and Rough Grading Only Black Horse Golf and Country Resort Kincardine, Ontario Contract No. GLD001

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
: Black Horse Golf and Country Resort
Address of Owner
R.R. #4, Kincardine, ON N2Z 2X5
Name of Contractor
Ontario Golf Construction
Address of Contractor
34 Berczy Street, Suite 230, Aurora, ON L4G 1W9
Name of Certifier
The MBTW Group
Address of Certifier
240 Duncan Mill Road, Suite 500, Don Mills, ON M3B 1Z4

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

Black Horse Golf & Country Resort c/o Gilbro Ltd., 1257 Kamato Road, Mississauga, ON L4W 2M2