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WE, <br />Company ID Murnber'. 486671 <br />.North American Industry <br />Classiffeatfon Systems- <br />- <br />236 <br />Administrator <br />Number of Employees: <br />100 to 469. <br />Kfumbpr of Sites Vefifi ed <br />for: <br />1 <br />Are you YeAfying for more than 1 site? If yes, please provide the number of sites verilded for <br />in, each State, <br />INDLANA I <br />Information relating to -the- Program Administrator(s) for yourCompany an policy <br />questions: or operational problems: <br />Namei James I(eldsen <br />Telephbne Number: (�74) 287 - 1811 ext. 368. pax Number: { 174) 344 - 5--533 <br />E-mail Address, jke)[4sen @ uild.cow <br />Page ­13 of 13 1 5Veefy MOU for Employer I Revision Date 091010 wwwdhs.gov/E-Varify <br />