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0%,ti5C�L9r= ® I'11111��fi Ve r =I ', lPf x.+.avf ax. cim o:a <br />Company E® 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. It you have any questions, contact E-Verify at $88-464-4213. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />01110/2012 <br />Signature <br />Date <br />Department of Homeland Security m Verification Division <br />CIS Verification Division <br />Name (Please Type or Print) <br />Electronicail Signed <br />itle <br />01/10/2012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />iolkowsk! Construction, Inc. <br />Company Facility Address: <br />050 Ralph Jones Dr. <br />South Bend, IN 46629 <br />Company Alternate <br />Address: <br />County or Parish: <br />Si JOSEPH <br />Employer Identification <br />Number: <br />351445992 <br />Page 12 o€13 1 E-Veriiy VIOU for Employer I Revision Date 09/01/09 vvvm.dhs;.gov/E-VerifV <br />