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s�[4 <br />® i�, <br />Emf <br />Y <br />a.a r� <br />Company ID Number: 486671 <br />To be accepted as a participant In -Verify, you should only sign the Employer's Section <br />of the signature page. if you have any questions, contact -Verify at 586-464-4218. <br />Employer Ziolkowski Coustruction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />#le <br />�111012012 <br />Signature <br />Date <br />Department of Homeland Security — Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />ElectroWically Signed <br />I#le <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 />Ziolkowski Construction, Inc. <br />Company Facility Address: <br />4050 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />Count or Parish: <br />5T JOSEPH <br />Employer Identification <br />Number: <br />P61446992 <br />Page 12 of 13 1 E-Verlry NOU for Employer 1 Revision Date 09/01109 www.dhs.gov/E-Verify <br />