‘Tous beloffanty SMALL EMPLOYER-BASED CHILD-CARE OR TEMPORARY Foon Preece SHELTER CHILD CARE FACILITY APPLICATION aoa SHELTER GD CANE FAGLITY ACPLATION, tiene [eat Tens Fay Residential Center, CCA South Texas LLC, Coretons Corporation of Ameria [8303766500 bea a eC a Soa is25W.rghway 83 Diley, Texas 78017 lo oT ise ine Ci ayy gto fie Dt pin sila MLC i wa [BB remmrry Seer Chen iy By dng sox, am cing hs epetin a Tes Sher CEC ay ex Is ae eset ey eer ier ata Dhl ol oe ch mae PART 1 APPLICANT INFORMATION [Grranwestip Cluinked Pace C) Sole PrptehipC] LiniedLnilyParesip Lined Lily Company [Dicopersion C1Non-poseCerparsion C) sine Opered Noro Corporation w/ Religious Aiton 1 Astcition —C.Non oft Aseciton Pott Sabin C)_Nov-rof Asocinion w Regios Afton Fa on ui pe oT ame a ss sn yea pe a rena SOLE PRontieToRSP Ok PARTNERS “Avion, Copan ined Lapis Compan, ‘Geren Lined Punt Linked Uti Pannen) || Nox-PatCoporatin Nort Asocain Fell! Savion, onset Co, wih fcigow Atta, Men Prof Asecison wi "Relgiur Aisne Stats Opes hero [Ec South Texas LLC aka Comstions Corporation of America “ee [0 Burton Hils Biv TTR TT TTA — isle, TN 37215 leas [asian er is63-3000| [aE arene TES foo-coaasat Pa IAT PART IIL-PERMIT HISTORY Dox hs prt caren ve ape prove my oer pe afehMemsar ching eM CFEC a By ‘ater snlein orem edie! es os tyes spect ype of emit: NA. ss his operons permit ben deied or eke it th PS? our ne Dyes Bl ve tyes expe: Na Give te dato be sco: NA’ Openson'sadines NAL Civete ype foperion: NAL asp ofthe program ber deena beeen? cnnneaeniinnence L] Yes No tyes xpi a ‘NOV.1020" totsTepeedTouwy SMALL EMPLOYER-BASED CHiILD-CARE OR TEMPORARY Toma Pes SHELTER CHILD CARE FACILITY APPLICATION. toa svt no ttn eo hy ie fe ‘Etiam mmole sho ou ces by oemcing oar ese eee PARTIV -OTHER INFORMATION INFORMATION FOR TOFS Prone dO s7Es00 Face STEED EMA Acres: nice Killneracon Wed PaneAdsess: Negi wwowseacom Pogers (Nowe conPhones 519 292019 ‘OPERATION (Prose a7 Hourscfopeaion: _Bexintine 8:00am. Endtine 8:00pm. ays of operation: | BMonday Tuesday —DWesnessay—LTuaday day Sauday Sunday | Menino Operation: Yea rounder onvary Fess Caen Caen Omey Oven Duy Caust Taseplember ——Oatober CDNovemser December ges Senet Dives (ith 17 morhs) CBToden 18m -2ye0s) ELPresidagaoen(Syears=< yeas) Scotoge (8 yan cen DIRECTIONS TO LOCATION: (ate ge caer conection) From sustin TX Head Easton Est S Srect toward Srazo St ‘Tor eght onto N Intestate 38 Frontage Road ‘Tate be ramp on the left onto F38 South Keep agate ork to stay om 38 Koop ft ate frk to stay on 138 8 ‘Take Ext 8 toward Teseicarrzo Springs ge ono 35 Frontage Road ‘Tom ght on 1x38 W (Destination on et Froman Antoni, Tx ead east on Dolorosa toward Main Plaza entre onto West Market Stost ‘Fomtt onto Novaro Steet Take be tattonto ECommerce St Turns onto Lain SUM Pecos St {ake te ramp on the et nto 10138 S “Tak te Bx 84 toward Tss/Carizo Springs reson 15 Frontage Road Turn Fight onto TX65 W (Destination wil be on the lf ‘NOV 10 204 2ol4‘Tyg omertam SMALL EMPLOYER-BASED CHILD-CARE OR TEMPORARY tee ‘SHELTER CHILD CARE FACILITY APPLICATION tos ines eh en obi eaten ct toy mere Nore: 2 persone requesting @ Cercle of Conplancs have he opton of weg hitcre atin SR elation estes beeen tere. Con yur ig oe lelomatin cantina in Bis Request maybe equce by tw be elated oe pl PART V-APPLICANT SIGNATURE: "ea tate nfration cota po wilfl mirepesntaion er ifialon sd tha is wea compete tothe best of {nolo end bel vderstans ht yl represen (cass or mete desi te apletn or er ‘evocation ofthe pei The dcumentatan 0 comple hie ppiation i stached (oe eect btw). f= tht ths ‘opsaon is rowed x per, here il be aac dscrimlation ithe néison oer of ei TE veremion of Fe Payment Gy Fir Pian ncongsmensions of he ndor ud enor ars) ies, ont Si OF BR) nequet for Criminn sory and Cen Regist Cock a Fngerrn rect (raplabie) ‘document ant ele fara Temperary Sheer ChildCare Faciy FORDFPS USE ONLY ‘inal — [Sue Reasved [Oats Bitared — Sale histor Comins "Sana [Bats acaes | Bate iad | Oat Ragiey Copied ‘aia Raauesl | Dale ‘ae Fea [Aout Pa [aioe oT oo rece ‘ecmntea | Vertes estenion am raqustog# Caress of Compliance rom the Texas Department of Family and Prontive Service © i eeleyer ted nt aye roe to comply wie Daprtmant es {alas catty that he nfomation have given cantane no wit mareprerentation ofc aon a trusand complete fo te bet of ry Enontadge ana btet | undertand a any wil eepre {crtarmrists dana or evoealon fy Caron of Complonce thorized Texas Department of Family and Protective Sori to contac poopl ted onthe frm. | ‘unre tha Tora Deparones of Publ Salet to eebee menial lor record ifomaton fo the Texte Siac yoy 10 204 otaTey owtottanyy SMALL EMPLOYER-BASED CHILD-CARE OR TEMPORARY Tene ort Praec areas ‘SHELTER CHILD CARE FACILITY APPLICATION “Tair perso eH no oh ito le eet oy mem ef et SSRIS cingericncneneeme™ PART VI-DFPS USE ONLY. a) PART VII-OPERATION DATA. AMENDMENT DATA Bessa Wem Si oe ctr am i ole-24 lism ee gta ior io Ta ‘0 am-600 pm hn 7 jonday Friday Pe Lor fewesemamer SCR SE cid ove he age of 11 years wil be fronted - [The Chit Care Area will only be tized Wor oters that have lesa and atomey lrpoinimens, medial opponents, end fer sila ppoiments This ae wil a ewe for ashes tht wan 0 aed ereatonl typeof activites fo leisure purposes. The Child Care wl ony bs aval for chien of siden nd ot or ileen of po la aT a Ta fore aa By: by: by ota NOV 20 20%Comparains Seton POs 13697 ‘atin Teste 71-3607 Nandita Berry ‘Sere a Sse Office of the Secretary of State Certificate of Fact “The undersigned, a Secretary of State of Texas, does hereby catify thatthe document, Application for Registration for CCA SOUTH TEXAS, LLC, authorized under the name Corrections Corporation of ‘America South Texas, LLC (File number 802074158), a MARYLAND, USA, Foreign Limited Liability Company (LLC), was fled in this office on September 30, 2014 It is further cerified thatthe entity status in Texas isin existence Intestimony whereof, Ihave hereunto signed my name officially and caused to be impresseeheteon the Seal of State at my office in Austin, Texas on October 27,2014 Aworafe0ry Nandita Berry Secretary of Sate Come vat won he tert tp: tte a Fav G12 a63<70> Por: ($13 4685858 Diak 7 for Rly Servis repre by: SOS-WEB “Tp. ase ‘Dec 75369610003 Noy 10 204Nandita Berry SeoearyoSie Corporations Seeion POBox 13677 ‘texas PUL 3697 Office of the Secretary of State ‘The undersigned, es Secretary of State of Texas, does hereby certify thatthe attached is a tre and -carect copy of each document on file in this office as described below CCA SOUTH TEXAS, LLC Filing Number: 802074158 Application for Ressraion September 30,2014 In testimony whereof, Ihave hereunte signed my name ‘ficially and caused fo be impressed hereon the Seal of State al my afFce in Austin, Texas on October 27, 2014 Nanoirakeney Nandita Berry Seerotary of State Come sr the ern ape sos tat Prove: 2) 4638888 Fav-(12)463-5709 Dik 71S Rly Senet Prepac by” SOS-WEB “Ho: vaee ‘Deca! 55363610008 Nov 10 204easel aoe staking Fane 512 463-5555 Registration SEP 30 204 Filing Fee: $750 Liability Company jons Section 1, The entity isa foreign limited lability company. The name ofthe entity is: CCA SOUTH TEXAS LLC. Pr i a el ane Poe Be tio ane TTA TI 2A. The name ofthe entity in is jurisdiction of formation doesnot contain the word “Limited ibility "or “linited company’ ot an abbreviation thereaf)-The name ofthe entity with the word ot 2B. Theentity name is notavilable in Texas, The assimed name under wich the entity wil qu fad tranect business in Texas is: corrections Corporation of America South Texas, LLC iT a ON TT TST Se tn om 3. Is federal employer ideniieation number is: 3] Feiseral emplayer identification number information is note lable a this ime. 4, Ris orgenizedunder th laws of: at tht ign) Mayan and the date of tsformation in that jurisdiction is: 60772016 — 5. As of the du of filing, the undersigned certs that the foreign limited liability company rently exists asa valid Vented lisbilly company under the laws of te jurisdiction of ts formation. 6. The purpose or purposes of the limited lability company that it proposes to pursue in the transaction of busines in Texas are set forth below. teenage in any nd lil snes or vies in which ited Hit campy may engender pple a “Ti entity leo certifies ates authorized vo pursue such sated purpose or purposes inthe site or country under which itis organized 7. The date on which the foreign enlty intends to transact business in Texas, or the date on which the: toeign entity fs: wansacted business in Texas is: 99252014 ming Ta rma a aa 8, The principal efice acess ofthe limited liability company is 351 We Caden St a mo__usa__an01 Sa ne ca RT RECEIVED G Forme SEP 3924 & moc: ntnene Secretary of State NOV 10 2049A: The registered agent i an organization (cnet ty named atv) by the name of CT Corpomsion Sysem C1 9B, ‘The reistered agent isan invidual resident ofthe state whose name i: 9C. The business addres of the registered agent and the registered office addres is 1999 Bn St. Sut 900 ats TX _ 72006 Serdar oo ae Zico 10. The enty hereby appoints the Secretary of State of Texas as is agent for service of process under (he circumstances set forth in section 5.251 ofthe Texas Business Organizations Code, 11. The name and address of each governing person i: TRAVIE-ARD ADDRESS OF GOVERNING PERSON er tmoare ool wm pa IRAN) on aa ar 0B il Boer hie TW _usA_ sms [ RAE AND ADDRESS OF GOVERNING PERSON tw ivranecaoes incl opine bimaon) | ed rae ar ae Tag aE oe Taxa To ABE TRO ADGRESSOF GOVERNING PERSON i 0 SoS wo oe eae Ta Crea Te Nov 10 aw‘Sepplemental Provislons/Iaformation et Ae Teena non ay enor by Eflectivenes of Flag Setter 8,00) ‘Bi This docunent becomes effective when the document fled by the secret of state B.C This document becomes effective at eter dete, wich snot more the ninety (90) dys fom ‘he dt of slgnig, The delayed effective dates ¢. [This document tkes effect upon the occurence oF fue event or fet, ofher han the passage of ime, The 90° day ater the date of signing is: “The following event rfc wil cause the document ake ffx inthe manner deseribed below: Execution ‘The underdigne! aff that the person designated as registered agent has consented (0 the ‘appointment. The undersigned signs this document subject tote penis Imposed by law for he ‘submission ofa materially alec foudulen instrument an eres une penalty of perjury thatthe Undesignd is wulorized under the provisions of law governing the enity fo exenue the Sling Scot Cnc a —————— ote: 992014 Woy 10-204Tegal ‘Small Employer-Based Child Care Faallity reree "Temporary Shelter Child Care Facilty FEE SCHEDULE Cr Pease check his change address Tae aration NUT (on POT “aon Nae oa [eso S300 South Texas Fanily Residential 11s i anew operation, check hs box C] iy Cau. 85 pilley ENG 78017 jess: Janice Killianioce “ibe OF Fee BERG PAD TE Fopheaion Foe 535 Tp Baerga Chk Fa | Harbor ef Pans bakig checked: A ¥8E TOTAL AMOUNT OF FEES Fee oem ‘Stale Law reques the Texas Deparimont of Famly and Preicive Sevices 0 collec ees fr issn leenss,regiraons| nd Ieings ond lor sondueting Background checks. Fees recelvod by Ine Deparment are deposed in the sists gers ‘evenuo nd. “Tha Human Resources Code, Chaper 42 establishes he flowing fee sched ‘A nometundable fee of $35 fr an fla! eppicaion or complancecerlicte lo opeale& chid care operaion or cit ‘lacing agency, The fo it pad when teapot is submit. Background Check Fee: $2.00 fe por person, pald each ime a Criminal icory and Ceiral Registybarkeround check requested. Directions for Sending Payment: 1. Please send only ONE CHECK oF MONEY ORDER for tho ene amount. Please D0 NOT SEND CASH 2. Make chock or money order payable to: Deparment ol Family end Protective Services ‘8. Mall this completed form and your chock or money ord ‘exes Deparment ol arly and Proecive Senices Ucensing Foe ‘courting Dison E672 P.O, Box 149090 ‘Astin, Texas 78714-0090, 4 Keep copy of your eanesled check or money order for your records, NO RECEIPT WILL BE SENT Noe: This form and your payment wl be returned to you i: Te lom ebank or incompiae You do not snd the crac fee amount S Yousendeesh OV 10 2018