Form ID

Publication date

Location of premises

Certificate

Contract No. M135, Sportsman Camp Development - Phase 1, Site Servicing.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Roy Investments Ltd.
Address of Owner
P.O. Box 159, Pain Court, ON N0P 1Z0.
Name of Contractor
Amico Contracting and Engineering (1992) Inc.
Address of Contractor
2155 Fasan Drive, R.R. #1, Oldcastle, ON N0R 1L0.
Name of Certifier
BTS Consulting Engineers.
Address of Certifier
1725 North Talbot Road, R.R. #1, Windsor, ON N9A 6J3.

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

Roy Investments Ltd., P.O. Box 159, Pain Court, ON N0P 1Z0.