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Company I® 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 Ziolkowskit Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically �igned <br />Tile <br />01/10/2012 <br />Signature <br />Rate <br />Department of Homeland Security m Verification Divisioli <br />CIS Veriiiication Division <br />Name (Please Type or Print) <br />Electronically Signed <br />Ale <br />01/1012012 <br />Signature <br />t]ate <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 />050 Ralph Jones Dr. <br />Bend, IN 46620 <br />-South <br />Company Alternate <br />Address: <br />County or Parish: <br />�ST JOSEPH <br />Employer Identification <br />Number: <br />351445992 <br />Page 12 of 13 1 E-Verify MOU for Employer I Revision ©ate 09/01/09 mww.dhs.gov1E-Verify <br />