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PM 11L <br />0 6eR` <br />-1 <br />-Verl <br />FY- <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 you have any questions, contact E-Verify at 888-464-4218. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Prinl) <br />Electronically Signed0111012012 <br />Title <br />Signature <br />Date <br />Department of Homeland Security m Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Electronically Sighed <br />ille <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 />060 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />Count or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />P51445992 <br />Page 12 of 13 1 E-Verify NOu for Employer I Revision Date 09/01/09 wtn w.dhs.gov1E-Verify <br />