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E—Ver <br />b`.r � lillll �a <br />3NWs-ice <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 your have any questions, contact -Verify at 888-464-4218. <br />Employer Ziolkowskti Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />itle <br />01J1012012 <br />Signature <br />rate <br />Department of Homeland Security — Verification Division <br />CIS Verification Division <br />Name (Please Type or Print) <br />Efectronicail Signed <br />itle <br />0111012012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />information relating to your Company: <br />Company Name: <br />lolkowski Construction, Inc. <br />Company Facility Address: <br />©60 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />P51446992 <br />Page 12 of 13 1 E-Verify MOtl for Employer I Revision Date 09/01/09 www.dt-is.gov/E-Varify <br />