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N <br />Company ID Number: 486671 <br />i by .may. SECG <br />CY d� <br />S <br />V A y <br />To be accepted as a participant in E-Verify, you should only Sign theEmployer'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 />Title <br />01/10/2012 <br />Signature <br />Date <br />Department of Homeland Security -^ Verification Division <br />CIS Verification Division <br />Name (Please Type or Print) <br />Electronically Signed <br />itle <br />0111012012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />Zlolkowski Construction, Inc. <br />Company Facility Address: <br />4050 Ralph Jones Dr. <br />South Send, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />T JOSEPH <br />Employer Identification <br />Number: <br />351445992 <br />Page 12 of 13 1 E-Verify MOU for Employer 1 Revision Date 09101/09 ww.d hs.gov1E-Verify <br />