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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 Ziolkowskll __....... . _ ... <br />.�._...�._ <br />Construction, Inc. <br />Dill Favors <br />Name (Please Type or Print) Title <br />Electranicall Siggned 1/10/2012 <br />Signature Date <br />Department of Homeland Security - Verification Division <br />USCIS Verification Division <br />Name (Please Type or Print) _ itle <br />Electronically Signed 1/10/2012 <br />.._.......�... ..�........ — .. _........ <br />Signature Date <br />_ .._ ._: _ ....... <br />Information Required for the E-Verify Program <br />Information relating to our Comany: <br />_ _. ..... ...�.�.............._�......._..� <br />Company Name: l' iolkowski Construction, Inc <br />I <br />Company FacilityRalph Jones Dr. <br />Address: 050 .. p <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />ITITITCounty or -.._S .EPH �wm ......w_. Pans T JOS _�...��...__._ - � ._....__....�...�. ,_, <br />Employer Identification <br />Number: 351445992 <br />Page 12 of 13 1 E-Verify IAOU for Employer I Revision Date 09/01/09 iAmftAt.dhs.gov/E-�/p.rit'y <br />