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-Ve r I FV. <br />.�m.n isA [cc�ieEnFntu;,i�p _cc <br />NOV— <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 Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />itle <br />1/10/2012 <br />Signature <br />Date <br />Department € f Homeland Security — Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />0111012012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to yof r Company: <br />Company ]Name; <br />Ziolkowski Construction, Inc. <br />Cam an Facility Address: <br />4050 Ralph ,!ones Dr. <br />South Bend, IN 46626 <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 MOti for Employer I Revision Date 09/01/09 www.dhs.gov/E-tlerify <br />