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9 1-111T <br />E,-Ver'1mfy-. <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 />.................... <br />mplo�yer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) 'Title <br />ElecLrojjica//X,!Sa 01/1012012 ... . ....... <br />Signature (Date ........... . . <br />........ . . . . . . .......... . . . . . .. ............ . <br />................. <br />Department of Homeland Security - Verification Division <br />USCIS Verification Division <br />Name (Please Type or Print) Title <br />Electronically Signed 01/10/2012 <br />Signature Date <br />------ .. ....... . —1 <br />Information Required for the E-Verify Program <br />Information relatincl to yo r Company: . ....... .. <br />Cornp,a�ny Name:; Ziolkowski Construction, Inc. ... . . . . . ........ . ......... . .......... — <br />Company Facility Address: 050 Ralph Jones Dr. . ........... . . ....... . . . . . . . ............... <br />South Bend, IN 46628 <br />. . ......... . . - <br />Company Alternate <br />Address: <br />County or Parish: STJOSEPH <br />.... ... .............. . ..... . . . . . . . . <br />Employer Identification <br />Number 1351445992 <br />Page 12 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 wvjw.dhs.gov/E-Verify <br />