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Form 460 - Maika Llorens Gulati for City Council 2020 (12-31-21)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 07/01/2021 through 12/31/2021 1- Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4, m &Ceholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure V Stag Candidate Election Cum mitic emlttee 0 Recall Controlled (aso0om#le1aPae6) (j .Sponsored ]eneral Purpose Committee raga Cen#kte Pee 6) Sponsored ❑ Primarily Formed Candidate/ Small Conlributor Committee Officeholder Committee Political PaVCantrat Commiltes rAsocarpfelePail 7) 3. Committee Information I.D. NUMBER Maika Llorens Gulati for San Rafael City Council District 12020 STREETADDRESS (NO P.O. BOX) 3177 STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX C TY STATE ZIP COOE AREA COOFaPHONE OPTIONAL: FAX! E-N1AILADDRESS D IE C IE 0 1:1 E If, COVER 17a1p Stamp wr ; FED 1 4 2022 - Data of election If app cable P 8e 1 of 5 (Month, Day, Yea CI CLERK'S OFFIC For Cftal Use On 11/03/2020 2. Type of Statement: Preelection Statement ❑ Quarterly Statement Semi-annual Statement ❑ Special Odd -Year Report Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Maika Llorens Gulati MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 NAME OF ASSISTANT TREASURER, IFANY MAILING ADDRESS C11 -1v STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my cer rtwr Executed on By Date Signature Of cbntrooing Officeholder, Candidata, Slate Meeaure Proponent Executed on By Gale Signature or Controlling Officeholder, Condldale, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice; adv1ce+`8fppc ca.gov (866/275-3772]0 www.fppc.ca.gow Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Maika Llorens Gulati OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member City of San Rafael District 1 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94901 Related Committees Not Included in this Statement: List any committees not Included in this statement that are controAed by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.Q. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODEIPHONE COMMITTEE NAME I.D. NUMBER ❑ YES ❑ NO CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE DISTRICT NO. IF ANY 7. Primarily Formed Candidate/OfficeholderCommittee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 07/01/2021 SUMMARY PAGE Expenditures Made 6. Payments Made................................................................ Schedule E Line 4 $ 0.00 7. Loans Made....................................................................... Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS ....................................... Add Lines 6+7 $ 0.00 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, line 3 0.00 11. TOTAL EXPENDITURES MADE ................. ...AddLines8+9+10 $ 0.00 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Paye, Line 16 $ 239.70 13. Cash Receipts........................................................... Column A, Line 3 above 0.00 14. Miscellaneous Increases to Cash ............................... Schedule i, Line 4 0.00 15. Cash Payments......................................................... Column A, Line 6 above 0.00 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ 239.70 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part2 $ 1-00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0.00 19. Outstanding Debts .............................. Add Line 2+ Line 9 in Column B above $ 0.00 $ 3174.47 0.00 $ 3174.47 0 0.00 $ 3,174.47 To calculate Column B, add amounts in Column Ato the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22, Cumulative Expenditures Made* (Ir Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov 12/31/2021 Page 3 of 5 SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER Maika 11orens Gulati for San Rafael City Council District 12020 1425910 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ 0.00 $ 3339.87 1/1 through 6/30 7!1 to Date 2. Loans Received.............................................................. Schedule B, Line 3 0.00 0.00 0.00 3339.87 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 0.00 0.00 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 21. Expenditures 0.00 3339.87 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED...............................Add Lines 3+4 $ $ Expenditures Made 6. Payments Made................................................................ Schedule E Line 4 $ 0.00 7. Loans Made....................................................................... Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS ....................................... Add Lines 6+7 $ 0.00 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, line 3 0.00 11. TOTAL EXPENDITURES MADE ................. ...AddLines8+9+10 $ 0.00 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Paye, Line 16 $ 239.70 13. Cash Receipts........................................................... Column A, Line 3 above 0.00 14. Miscellaneous Increases to Cash ............................... Schedule i, Line 4 0.00 15. Cash Payments......................................................... Column A, Line 6 above 0.00 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ 239.70 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part2 $ 1-00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0.00 19. Outstanding Debts .............................. Add Line 2+ Line 9 in Column B above $ 0.00 $ 3174.47 0.00 $ 3174.47 0 0.00 $ 3,174.47 To calculate Column B, add amounts in Column Ato the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22, Cumulative Expenditures Made* (Ir Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period from 07/01/2021 SCHEDULE A SEE INSTRUCTIONS ON REVERSE through 12/31/2021 Page 4 of 5 NAME OF FILER I.D. NUMBER Maika Llorens Gulati for San Rafael City Council District 12020 1425910 FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDARYEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY f1 SCC Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.)....................................................... SUBTOTAL $ 0 0.00 2. Amount received this period — unitemized monetary contributions of less than $100 ...............1,1-1,1,.,$ 0`00 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ Ol00 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded Statement covers period Payments Made to whole dollars. y from 07/01/2021 through 12/31/2021 I Page 5 Maika Llorens Gulati for San Rafael City Council District 12020 CODES: if one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1425910 Of 5 CMP campaign paraphemalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) NAMEAND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID IIF COMMITTEE, ALSO ENTER ID NUMBER) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) $ 0.00 2. Unitemized payments made this period of under$10Q.............................................. $ 0.00 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............. ........... $ 0.00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .................... TOTAL $ 0.00 FPPC Form 460 (Jan/2016)) FPPC Advice: adviceLalfppc.ca.gov (866/275-3772) www.fppc.ca.gov