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Aff MOF a�-� Jam'' aE"I'O-ven <br />Y <br />avrnu'i mAaRne4af m�siux er.5 <br />Company I® dumber: 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 EVerify at 888-464-4218. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />1/1012012 <br />Signature <br />Date <br />Department of Homeland Security - Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Electronically Signed <br />itle <br />D111012012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />iolkowskl Construction, Inc. <br />Company Facility Address: <br />4060 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 />361445992 <br />Page 12 of 131 E-Verily NOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify <br />