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� �y SeCG <br />Vert <br />Company W Number; 4866.71 <br />To be accepted as a participant in E-Verlfy,,yau shduld only sign the Employer's, Section <br />of the signature~ page. If you have any questions, contact E-Verify at 888-464-4218. <br />Ehipl6yfar Z;iol owsltf Gazisti R ti€►�, We. <br />Bill Favors <br />dame (Please Type or PrinQ <br />Electronically Signed <br />ritle. <br />01110/2012 <br />ig€pature <br />Dafe <br />Deparfinent of Homeland Security -- Verlticatlon pivlsion <br />SaS. Verification DivisioU <br />Dame (Please Type or Print) <br />Electronically Signed <br />TWO <br />pIIIO12012 <br />ignature <br />Date <br />Irtfhrmation Required For the E-Vedfy Program <br />Informatibn relating Wyo r Company: <br />Gone aleV Name: <br />`olkowsld Constructlon,, Inc. <br />Company Fadlit Address: <br />4050 RA[ph dories Dr. <br />Smith Send, IN 4E628 <br />Oompany Alternate <br />Address: <br />County or Parish: <br />i IOS1rPH <br />Enriployer ldentifteatlon <br />(dumber <br />514469.92 <br />Page 12 ofr!3 j £ Verify MOU for Employer ( Revision Bate D9!()fM 1Ni►f w.dhs.govIE-Verify <br />