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r=-Verify, <br />� wnx <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 />Employer9 Ziolkowski Construction Inc- _.. <br />. ,. <br />Bill Favors <br />W ............ <br />Name (Please Type or Print) Title <br />Efectronicall„y Signed 01/10/2012 <br />Signature Date <br />Department of Homeland Security - Verification Division <br />CIS Verification Division <br />Name (Please Type or Print) itle <br />Electronicail Signed _ _ 1/10/2012 <br />Signature Date <br />............ <br />Information Required for the E-Verify Program <br />Information relating to your Compan w <br />Company Name�Ziolkowski Construction, Inc. <br />Company Facility Address: 4050 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />Count or Parish: ST JOSEPH <br />Employer Identification <br />Number: 351445992 <br />Page 12 of 13 1 E-Verify NOU for Employer I Revision Date 09/01/09 uvvw.dhs.gov/E-Verify <br />