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va ,y5e[-4 <br />b��lll�llr� <br />E' Hvm.ry is Aamunaratu ua aca <br />Company l® 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. 888m464-4218. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronicall Sinned <br />tle <br />�111012012 <br />Signature <br />Date <br />Department of Homeland Security — Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Signed <br />T011110/2012 <br />oElectronicall <br />Signature <br />date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />iolkowski Construction, Inc. <br />Company Facility Address: <br />4050 Ralph Jones Dr. <br />kouth Bend, IM 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />P61445992 <br />Page 12 of 13 1 E-Verify NOU for Employer I Revision Date 09/01109 wvuw.dhs.gov/E-Verify <br />