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E Veri <br />Company I® Number: 486671 <br />-� � <br />�'`•s'irrn� <br />Tor 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 EVerify at 883-464-4216. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />We <br />01/10/2012 <br />Signature <br />date <br />Department of Homeland Security ® Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Eiectroniically Signed <br />�itle <br />10111012012 <br />Signature <br />Date <br />Information Required for the E Verify Program <br />Information relating to your Company: <br />Company Name: <br />Ziolkowski Construction, Inc. <br />Company Facilif Address: <br />4060 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />ST JOSEPH <br />Employer Identification <br />Number: <br />361445992 <br />Page 42 of 13 1 E-Verity KhOU for Employer I Revision Date 09/01/09 xwdw.r1hs.gov/E-VerWV <br />