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E-Verify-,u , <br />@q�3 <br />by�l�l�Il.c� <br />Company ID Number: 486671 <br />To be accepted as a participant in E-Verify, you should only sign the Employer's Section <br />of the signature page. If you have any questions, contact E-Verify at 888-464-4218. <br />Employer Ziolkowski Construction, Inc. <br />ill Favors <br />Name (Please Type or Print) <br />Electronicall Si ned <br />itle <br />1/10/2012 <br />Date <br />omeland Security — Verification Division <br />ation Division <br />r(Please <br />r Print) <br />Electronically Signed <br />itle <br />1/10/2012 <br />Signature <br />ate <br />Information Required for the E-Verify Program <br />Information relatin to our Company: <br />Corn an Name: <br />iolkowski Construction, Inc. <br />Company Facilit Address: <br />060 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />T JOSEPH <br />Employer Identification <br />Number: <br />51445992 <br />Page 12 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify <br />