Fee Calculation Worksheet

Name of School: v "r~ (~ ~ ~`~ (~(7 l S ~ ~C

City: State:

~~SIQ, ll.Initial Licensure Application and Student Protection Fund Fees:

Amount Owed Amount Paid

Resident School Yes No If yes, $500 fee

Student Protection Fund Contribution $500

Non-Resident School Yes No If yes, $1,250 fee

Student Protection Fund Contribution $1,250

A¢ent Fees:

Number of Agents: Multiply this number by $175 fee

COLSCHOOL

Application for Resident CDL School License Fee If yes, $500 feeApplication fee KRS 165A.475(2) $200 feeContribution to Student Protection Fund $500 feeNumber of CDL Instructors: Multiply this number by $220 feeNumber of Agents: Multiply this number by $175 fee

Application for Non-Resident CDL Schaal License Fee If yes, $1,250 feeApplication fee KRS 165A.475(2) 5200 feeContribution to Student Protection Fund $1,250 feeNumber of CDL Instructors: Multiply this number by $220 feeNumber of Agents: Multiply this number by $175 fee

RESIDENT AND NON-RESIDENT SCHOOL RENEWALTransfer of Ownership of School? (refer to application) Yes -or- No If yes, $500 fee

Chanze of Name of a School? Yes -or- No If yes, $150 fee

Chance of Location of a School? Yes -or- No If yes, $500 fee

Application to Award an Associate Dezree? Yes -or- No If yes, $750 per degree

Pro¢ram Revisions? Yes -or- Nofor 25% or more of an existing

program If yes, 5200 fee per program

for less than 25% If yes, $100 fee per program

Amount Owed Amoun[ Paid

Resident School Yes -or- No $500

Non-Resident School Yes -or- No $1,250

Gross Revenue =Total Amount of Tuition Earned -

Tuition Refunds paid to student from July 1, 2018 -

June 30, 2019 See how to calculate below:

How to Calculate Fees if Revenue is above $50,000 -refer to attached calculation sheet (additional $25 per $10,000)

New Prozramis): Amount Owed Amount PaidNumber of New Program(s): Multiply this number by $200 fee

A~en[Fees: ~,,/~ ~ ,,.y}~~—~

Number of New Agents: ~✓ Q.(,I(ll VI ~ ~~S (lX ~ "~ ~-~- - J(,

Multiply this number by $175 fee v~

Number of Agent RENEWALS: Multiply this number by $175 fee

CDL School? Yes -or- No If Yes, $200 Annual fee

Number of CDL Instructor RENEWALS: Multiply this number by $220 fee

Number of New CDL Instructors: Multiply this number by $220 fee

Site Visit: VariesLate Fee:r— __----------------------------------------ACTIONSTEPS A __',..,1 ;_I~^,n n, r. ~~ ~ /~ „~,, ,,~ ,2 ~To ee~O~p(e~/~

~̀ ~ ~`~~' ̀~ ~~II ~ , IT I Fee R

-------------------------------------------'iv

.-r~L~ ~~ .~$700.00

UNIVERSAL TECHNICAL INSTITUTE 776901

I NVOICE NUMBER INVOICE DATE REMARK GROSS AMOUNT DISCOUNT AMT NET AMOUNT

CR 10/24/2019 10/24/2019 700.00 0.00 700.00

776901 $700.00 $0.00 $700.00

Universal Technical Institute, IriC. WeIIs Fargo Bank, N.A 7]690

16220 N. Scottsdale Road, Suite 500

Scottsdale, Arizona 85254

(623)445-9500 56-382 PAY THIS AMOUNTUniversal Technical insritute - NASCAR Technical institute _ Yr _,. _ ^ ~ ~

ii■ 7 7690 Lii' x:04 L 20 38 24~: 96000 50 2 2 5ii■

UNIVERSALTECHIY/CAL►Nsr~rvrE

November 4, 2019

Misty EdwardsExecutive DirectorKentucky Commission on Proprietary Education300 Sower BoulevardFrankfort, Kentucky 40601

RE: Initial Agent Applications for Gregory Jones

Ms. Edwazds:

Harrre om~e16220 N. Scottsdale Rd., Suite 500

Scottsdale, Arizona 85254

" 800-859-7249 623-445-9500 - 623-445-9501

~G~~~J11SS/p\

~ ~

OEC 1 1 2019O

'P~,a~/~ O JGQ~

~rARYE~

Enclosed are the 2019 New Agent Applications, including photos, bonds, and fees for Gregory Jones for the followingcampuses:

• NASCAR Technical Institute —Mooresville, NC;

• Universal Technical Institute of Illinois —Lisle, IL;

• UTI Motorcycle-Marine Mechanics Institute —Orlando, FL; and

• Universal Technical Institute of Texas —Houston, TX

Should you have any questions regarding this submission, please do not hesitate to contact me at 623.445.9409 or via emailat jsavioli@uti.edu.

Sincerely,

W .<O'

Jessica W. SavioliRegional Compliance Analyst

Urt/vernal Technicallnst/tute Motorcycle Mechanics 1nsUtute Marine Meci~arUcs Insfltute NASCAR. TechNca! lnstftuGa Learn more: UT/.ea~

GoMN~t I ssia~_ ~_ n.t

KENTUCKY COMMISSION On PROPRIETARY EDUCA ION ~~~ 1 1 2p~9300 Sower Boulevard, Frankfort, Kentucky 40601

~sn2~ ~~a-4~R~ http://kcpe.ky.~ov -o

APPLICATION FOR PERMIT TO ACT AS AN AGENT ~~^~" ,,=o~c~P~aqs~_=~,INSTRUCTIONS TO AGENTS C

1. This application must be typed or printed legibly and completed in its entirety.2. Complete the School Agent Information and Agent Certification sections of this application.3. A recent passport-type photograph, 2"x 2", must be submitted with this application.4. The applicants name and social security number must be typed or printed legibly on the back of the

photograph.

INSTRUCTIONS TO SCHOOL ADMINISTRATOR

1. This application must be typed or printed legibly and completed in its entirety.2. Complete the School Information and School Certification sections of this application.3. Submit an original BLANKET AGENT SURETY BOND (PE-27) or Continuation Certificate with thisapplication.4. This application and all supporting material must be submitted with the application fee in accordance with791 KAR 1:025. This fee is nonrefundable. All fees must be submitted by check or money order madepayable to the Kentucky State Treasurer. DO NOT SEND CASH.5. Attach continuation sheets if more space is needed to provide information.6. Refer to KRS 165A.340(3); 165A.350(3); 165A.400; and 791 KAR 1:025.7. This completed application may be submitted to the Kentucky Commission on Proprietary Education by mailto 300 Sower Boulevard, Frankfort, Kentucky 40601.

SCHOOL AGENT INFORMATION

hereby make application for a permit to act as a school agent in the Commonwealth of Kentucky.

Jones Gregory S.

First Name Last Name Middle Initial Date

1311 Angeline Ave. Orlando FL 32807

Home Street Address City State Zip Code

(407) 625-5558 gregjones@uti.edu

Telephone Number Cell Phone Number Email Address

02/17/1972 69 192

Social Security Number Date of Birth Height Weight

UTI of Illinois, Inc.

Name of School you expect to represent.

2611 Corporate West Dr. Lisle IL 60532

Street Address City State Zip Code

1. Have you had a school agent permit before? ❑Yes ❑■ No

2. Have you ever been refused an agents permit in any state or had it revoked or suspended? ❑Yes ❑■ No

3. Have you ever been dismissed from any position for immoral or unprofessional conduct? ❑Yes ❑■ No

4. Have you ever been convicted of a felony violation of the law? ❑Yes Q■ No

If Yes to any of the questions above, please explain the circumstances fully on a continuation sheet, markedF~chibit A.

~"~~"-PE-19 2017 Page 1 of 2

11:

KENTUCKY COMMISSION Ofl PROPRIETARY EDUCATION300 Sower Boulevard, Frankfort, Kentucky 40601

(502) 564-4185 httq://kcpe.kv.pov

APPLICATION FOR PERMIT TO ACT AS AN AGENT

AGENT CERTIFICATION

certify that the information provided on this application as submitted to the Kentucky Commission on ProprietaryEducation is true and correct in its entirety. In addition, I hereby pledge to follow all standards set out in KRSChapter 165A and all rules and regulations set out in 791 KAR Chapter 1.

Gregory S. Jones Admissions RepAgent Name Title

SCHOOL INFORMATION

UTI of Illinois, Inc.

School Name Date2611 Corporate West Dr. Lisle IL 60532Street Address City State Zip Code(630) 529-2662 www.uti.eduTelephone Number Fax Number Website AddressJessica W. Savioli Regional Compliance AnalystAdministrative Contact Person Name Title16220 N. Scottsdale Rd., Suite 500 Scottsdale AZ 85254Administrative Contact Person Address City State Zip Code(623) 445-9409 (623) 445-9425 jsavioli@uti.eduAdministrative Contact Phone Number Fax Number Email Address

This agent is covered by a Five Thousand Dollar ($5,000.00) surety bond as indicated by

Q BLANKET AGENT SURETY BOND (PE-27)

❑ Continuation Certificate

Continuation Certificate Number 024019427

Insurance Company Liberty Mutual Insurance Company

Effective Date of Certificate 06/30/2019

Expiration Date of Certificate 06/30/2020

CERTIFICATION

certify that the information provided on this application as submitted to the Kentucky Commission on ProprietaryEducation is true and correct in its entirety. I further certify that the applicant named above is of good moralcharacter and will be employed by the school named above after receiving a permit issued by the KentuckyCommission on Proprietary Education. In addition, I hereby pledge to follow all standards set out in KRS Chapter165A and all rules and regulations set out in in 791 KAR Chapter 1.

Jessica W. Savioli -Regional Compliance AnalystSchool Official Name

PE-19 2017

Title

Gregory S Jones oae'~' 0;9 0 ;Y,s' 90 ~;.00 = 24 October 19Agent Signature Dat

Jessica W. Savioli D"gitalty signed by Jessica W. SavidiDate: 2019.1024 73:59:48 -07'00'

School Official Signature Date

Page 2 of 2~ s

c

CONTINUATION CERTIFICATE

The Liberty Mutual Insurance Company (hereinafter called the Surety)hereby continues in force its Bond No. 024019427 in the sum of Twentv ThousandDollars and 00/100 ($20,000.00) Dollars, on behalf of Universal Technical Institute ofIllinois, Inc. in favor of Kentucky Commission on Proprietary Education subject to all theconditions and terms thereof through June 30, 2020 at location of risk.

This Continuation is executed upon the express condition that the Surety'sliability shall not be cumulative and shall be limited at all times by the amount of thepenalty stated in the bond.

IN WITNESS WHEREOF, the Surety has caused this instrument to be signed byits duly authorized Attorney-in-Fact and its corporate seal to be hereto affixed this5 day of April, 2019.

Liberty Mutual Insurance CompanySurety

i~

By:oshua ord Att - ~y-in-Fact

This Power of Attorney limits the acts of those named herein, and they have no authority tobind the Company except in the manner and to the extent herein stated.

Liber~ Liberty Mutual Insurance Company

Mutual. The Ohio Casualty Insurance Company CeNficate No:6196860-985949West American Insurance CompanySURETY

POWER OF ATTORNEYKNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the lays of the State of New Hampshire, thatLiberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organizedunder the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Ai~aAnderson, Samucl E. Bcgun, Saykham Chanthasone, Lorina Monique Garcia, Danielle D. Johnson, Michelle Anne McNfahon, Aimee R. Perondine, MerceJesPhothirat6, Jenny Rose Belen Phothirath, Noah William Pierce, Donna M. Planets, Joshua Sanford, Bethany Stevenson, liric Strba, Jynell Marie Whitci~ead

all of the city of Hartford state of Connecticut each individually if there be more than one named, its We and lawful attorney-in•fact to make,execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuanceof these presents and shall be as binding upon fhe Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own properpersons.

IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixedthereto this 18th day of September 2018

Liberty Mutual Insurance Company~ ~NSUR ~,tY ~NgG a \NSUq The Ohio Casualty Insurance Company

,̀JP̀ aaPorr,~r~t~, gJP4owvo~r'Pgy VP 4oQao~ qy~ West American Insurance Company ~J r o t~ 7 3 `~o C~ Q- 3 `~o m ~~ 1912 ~ 0 1919 ~ f 1991 ~ ~ ~fn

d,'~ '~ACHU9C' ,aD O ~r~AMP9~ L~ ~( ~NO~PN~ D ~ ~ ~ ~ d~ 9i~ * ti~ dyl * ~Nd

SAM ,r 1~~~ BY' "rn~ David M. Carey, Assistant Secretary ~,- ~ State of PENNSYLVANIA

~~ County of MONTGOMERY ss ~o~

~~ ~ On this I8th day of So tembcr 201 K before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance oi ~ Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes =~~ j therein contained by signing on behal(ot the corporations by himself as a duly authorized officer. v w

IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. E o~.~ o~ N Q~`~P~PgSrF~ COMMONWEALTH OF PENNSYLVANIA QOM.'~. ~/ O~ 9~~ y Noiarlal Seai /f ~ 'pN 0 ~ U OF ~ Teresa Pastelle, Natery Public ~ ~;~~~ ~ p ~p ~ Upper ~MerionTwp., Montgomery County By; ~~~~~C~l~/ ~ ~

C ~ •j.'~,M.SydP~̀`f p My Commission Expires March 28, 2021

eresa Paste s, Notary Public o ~~ OT~~ ~0J Member, Penruylvania Association of Notaries ~ O

N~.0 m This Power of Attorney is made and executed pursuant to and 6y authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance ~ ~p.e Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: o ~~' a~~ a; ARTICLE IV —OFFICERS: Section 12. Power of Attorney.

o c̀u Any officer or other oKdal of the Corporation authorized for chat purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or ehe President ~ ~~ T may prescribe, shall appoint such attorneys-in•fact, as may be necessary to act in behaii of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all ~ ov undertakings, bonds, recognizances and other surety obligations. Such attorneys-in•(act, subject to the limitations set forth in (heir respective powers of attorney, shall have full ~~~ ~ power to bind the Corporation by their signature and execution of any such instruments and !o attach Iharalo the seal of the Corporation. When so executed, such instruments shall ~ ~o ~— be as binding as i( signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this ENZ v article maybe revoked at any lime by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ~ m~c .00ARTICLE VIII —Execution of Contracts. Section 5. Surety Bonds and Undertakings. ~ ~Any o~cer of the Company authorized for That purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, ~ rshall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknovrledge and deliver as surety any and all undertakings,bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind theCompany by their signature and execution of any such insirumenls and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as ifsigned by the president and attested by the secretary.

Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys-in-fact as maybe necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other suretyobligations.

Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of theCompany, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company withthe same force and effect as though manually affixed.

I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company dohereby certify that the original power of ariomey of which the foregoing is a full, true and correct copy of the Power o(Attorne executed by said Companies, is in full force and effect andhas not been revoked. ac ~ ~, ~ i~ ~, ~~IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this ,) day of ' ~ , ~~~

~ ~NS~,P tY INS \NSU '/~JP'̀ oaror~roy~c~

E'

y ~ 1912 y o

Yd '9s4CNU9~da~9j~ * ties

LMS-12873 L'v11C OCIC WAIC Multi Co 062018

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0 1919 ~ f 1991 ~y y p~, ° a y° By:~ ~~~~wea`~,da~ ifs, ~NnuHn ,dD~'H1 * ~,d ~lyt * tits

~~~

Renee C. Llewellyn, Assistant Secretary