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-Verify.-.01,10 <br />imeeiyR�4�l.(e.. R*a a.R <br />Company ID Number: 486671 <br />Tq 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 888-464.421S. <br />Employer Zioikowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Si ned <br />Vile <br />0111012012 <br />ignature <br />Date <br />Department of Homeland Security — Verificaflon Division <br />SC}iS Verification Division <br />Name (Please Type or Print) <br />Electronically Si ned <br />itie <br />01/1012012 <br />Signature <br />Date <br />Information Required for the I~ -Verify Program <br />Information relating to your Company: <br />Compan Name: <br />Volkowski 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 />STJOSEPH <br />Employer Identification <br />Number: <br />361446992 <br />Page 12 of 13 1 E-Verity MOM for Emptoyer l Revision Date 09l01l09 www.dhs.gov/E-Variiy <br />