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� a3••"'� c?"y sec�� <br />Ver :...E1 f �,z <br />s'�Ilul� <br />Off <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 />Employer Ziolkowsld Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />01/10/2012 <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 />Title <br />01110/2012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />Ziolkowski Construction, Inc. <br />Company Facility Address: <br />4050 Ralph Jones Dr. <br />South Bend, 1N 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />351445992 <br />Page 12 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify <br />