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-y SECGr <br />FM IL <br />vsa a <br />-ven <br />�% ��cn�nttRSQmtenF�urniesec <br />Company ID dumber: 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 333-464-421 & <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />ElectronicallySigned <br />itla <br />0111012012 <br />Signature <br />j....jDate <br />Department of Homeland Security m Verification Division <br />SCYS Verification Division <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />01/10/2012 <br />ignature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />iolkouvskl construction, Inc. <br />Facility Address: <br />4060 Ralph .!ones Dr. <br />-Company <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />1 <br />County or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />P51446992 <br />Page 12 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify <br />