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sECG <br />gn,Rp <br />Company ID Number: 466671 <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, Gontact E-Verify at 686-464-4213. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />Tiffe <br />01/10/2012 <br />Signature <br />Date <br />Department of Homeland Security — Verification DiVISian <br />,BUTS Verification Division <br />Name (Please Type or Print) <br />Electronically Signed <br />itle <br />01I1012012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Compan Name: <br />iolkowski Construction, Inc. <br />Cam p any Facil itv Address: <br />4050 Ralph .Tones Dr. <br />South Send, IN 46628 <br />Company Alternate <br />Address. - <br />County or Parish: <br />ST JOSEPH <br />Employer Identification <br />Number; <br />P51445992 <br />Page 12 o€13 1 E-Verify Nni1 for Employer I Revision Date 09/01/09 vmm.dhs.gov/E-VGrifyy <br />