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Home My WebLink AboutBobby Khullar for Dublin City Council - 2018_460 Recipient Committee Date Stamp COVER PAGE Campaign Statement CALIFORNIA 460 RECEIVED FORM Cover Page • Statement covers period Date of election if applicable: JUL 2 0 2018 Page 1 of 7 from 1/1/2018 (Month,Day,Year) For Official Use Only CITY OF DUBLIN SEE INSTRUCTIONS ON REVERSE through 6/30/018 11/6/2018 CITY MANAGER'S OFFICE 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: Z Officeholder,Candidate Controlled Committee 0 Primarily Formed Ballot Measure 0 Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee V Semi-annual Statement 0 Special Odd-Year Report O Recall 0 Controlled 0 Termination Statement (Also Complete Pail 5) 0 Sponsored (Also file a Form 410 Termination) (Also Complete Part 6) 0 General Purpose Committee 0 Amendment(Explain below) 0 Sponsored 0 Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D.NUMBER Treasurer(s) 1404867 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Bobby Khullar for Dublin City Council-2018 Mike McMahon MAILING ADDRESS 333 Haight STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE 5522 Eaglebrook Terrace Alameda CA 94501 510-523-2263 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY Dublin CA 94568 510-584-6760 MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 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 knowledge the information contained herein and in the attached schedules is true and complete. certify under penalty of perjury under the lawns/of the State of California that the foregoing is true and correct: Executed on3/4/ . irfili ` 2 12 " By Signature of Treasurer or ss'tent Treasurer f I' 2� t / Executed on By / / Date Signature oiling Officeholder,Candidate,State Measur roponerkSl or Responsi Cmr-ofSponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent • FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) +11 COVER PAGE-PART 2 Recipient Committee CALIFORNIA Campaign Statement FORM 460 Cover Page — Part 2 Page 2 of 7 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Bobby Khullar OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT Dublin City Council CI OPPOSE RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder,candidate,or state measure proponent,if any. 5522 Eaglebrook Terrace Dublin CA 94568 NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO.IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Cl SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D.NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD CI YES CI NO CI SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE 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 Amounts may be rounded SUMMARY PAGE to whole dollars. Statement covers period Summary Page 1/1/2018 CALIFORNIA 460 ORM from SEE INSTRUCTIONS ON REVERSE through 6/30/018 Page 3 of 7 NAME OF FILER I.D.NUMBER Bobby Khullar for Dublin City Council 1404867 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions Schedule A,Line 3 $ 4851 $ 4851 1!1 through 6/30 7/1 to Date 2. Loans Received Schedule B,Line 3 _ 0 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+2 $ 4851 $ 4851 Received $ $ 4. Nonmonetary Contributions Schedule C,Line 3 _ 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ 4851 $ 4851 Made $ $ • Expenditures Made Expenditure Limit Summary for State 6. Payments Made Schedule E,Line 4 $ 863 $ 863 Candidates 7. Loans Made Schedule H,Line 3 0 0 8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 22. Cumulative Expenditures Made* $ 863 $ 863 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses(Unpaid Bills) Schedule F,Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment Schedule C,Line 3 0 _ 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ _ 863 $ _ 863 J_/ $ Current Cash Statement ___/____i $ 12. Beginning Cash Balance Previous Summary Page,Line 16 $ 0 To calculate Column B, 13.Cash Receipts Column A,Line 3 above 4851 add amounts in Column 0 A to the corresponding *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash Schedule!,Line 4 _ amounts from Column B reported in Column B. 15.Cash Payments Column A,Line 8 above 863 of your last report. Some 3988 amounts in Column A may 16. ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ _ be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED Schedule B,Part 2 $ 0 filed for this calendar year, only carry over the amounts Cash Equivalents and.Outstanding Debts from Lines 2,7,and 9(if any). 18. Cash Equivalents See instructions on reverse $ 19. Outstanding Debts Add Line 2+Line 9 in Column B above $ - FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA 460 from 1/1/2018 FORM SEE INSTRUCTIONS ON REVERSE through 6/30/018 Page 4 of 7 NAME OF FILER I.D.NUMBER Bobby Khullar for Dublin City Council 1404867 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE,ALSO ENTER I.D.NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Vivek Khullar ['IND 4/25/2018 5522 Eaglebrook Terrace ❑❑o�H Project Controls 500 500 Manager Dublin CA 94568 'DPW SF Metro Transportation ❑scc Rosa! Trolan El IND 4/30/2018 5803 Turnberry Drive �oTH Realtor 200 200 Dublin, CA 94568 III PTY Century 21 Cornerstone ❑scc Realtor D IND Puran Moorjani ❑coM CEO 4/30/3018 3196 Bellerive Lane ❑OTH DPP Tech 500 500 Dublin, CA 94568 ❑PTY ❑SCC IZI Purima Moorjani IND ❑cam Vice President 4/30/2018 3196 Bellerive Lane 500 500 ❑OTH DPP Tech Dublin, CA 94568 ❑PTY ❑scc Mike Grant lZi IND 5/21/2018 8035 Iglesia Drive ❑ Sales 200 200 OTH Dublin, CA 94568 ❑OTH Self Emplyed ❑PTY ❑scc SUBTOTAL$ 1900 - s , , Schedule A Summary *Contributor Codes 1. Amount received this period-itemized monetary contributions. IND-Individual (Include all Schedule A subtotals.) $ 4701 COM-Recipient Committee (other than PTY or SCC) 2. Amount received this period-unitemized monetary contributions of less than $100 $ 150 OTH—Other(e.g.,business entity) PTY—Political Party 3. Total monetary contributions received this period. scc-Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 4851 FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fonc.ca.eov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA 460 from 1/1/2018 FORM through 6/30/018 Page 5 of NAME OF FILER I.D.NUMBER Bobby Khullar for Dublin City Council 1404867 IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION CONTRIBUTOR DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Justin Gugajew ®IND Accountant 5/21/2018 1250 S. Tremaine Ave. ❑coM 200 200 ❑OTH Self Emplyed Los Angeles, CA 90019 ❑PTY ❑scc Poonam Gulati ®IND Medical Secretary 5/21/2018 3550 Pinot Noir Ct. ❑OTH❑COM Kaiser Permanente 101 101 Dublin, CA 94568 ❑PTY ❑scc Ritesh Khullar ®IND SVP 5/19/2018 9551 Joey Dare Ct. ❑❑OTH 0THcom Flatiron Health 500 500 Dublin, CA 94568 ❑PTY ❑scc V IND Rita Khullar ❑coM Self Employed 5/19/2018 9551 Joey Dare Ct. ❑OTH N/A 500 500 Dublin, CA 94568 • ❑PTY ❑scc William Carey ❑IND Finance 6/4/2018 4078 Rosehill Place ❑OTH['cowl OTH WideOrbit 250 250 Dublin CA 94568 ❑PTY ❑scc SUBTOTAL$ 1551 ° its ,, *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 A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.) to whole dollars. Statement coversperiod 460 Monetary Contributions Received CALIFORNIA from 1/1/2018 FORM through 6/30/018 Page 6 of 7 NAME OF FILER I.D.NUMBER Bobby Khullar for Dublin City Council 1404867 DATE FULL NAME,STREETADDRESSAND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Mukesh Idnani ®IND Sr Consultant OTH VM Ware 6/19/2018 3609 Whitworth Dr. ❑ 500 500 ❑OTH Dublin, CA 94568 ❑PTY ❑scc Lisa Lockwood ®INDcom Lawyer 6/19/2018 3830 Silvera Ranch Dr. ❑OTH Self Employed 250 250 ❑OTH Dublin, CA 94568 ❑PTY ❑scc Sasikumar Karuppusamy ®IND Solutions Architect 6/25/2018 9550 Joey Dare Ct. ❑0TH Apttus Corp 500 500 Dublin, CA 94586 ❑PTY ❑scc ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑scc SUBTOTAL$ 1250 *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(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded SCHEDULE E to whole dollars. Statement covers period CALIFORNIA 460 Payments Made from 1/1/2018 FORM • • SEE-INSTRUCTIONS ON REVERSE through 6/30/018 Page of 7 NAME OF FILER I.D.NUMBER Bobby Khullar for Dublin City Council 1404867 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/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 (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Netbrands Media 14550 Beechnut Street CMP 240 Houston, TX 77083 Three R Printing 2921 W. Burbank Blvd. CMP 288 Burbank, CA 91505 LynnPro 1625 13th Ave S, CMP 285 Clinton IA 52732 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 813 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 813 2. Unitemized payments made this period of under$100 $ 50 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ 863 FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov