State of California

S

Secretary of State
Statement of Information

FD53536

(Domestic Stock and Agricultural Cooperative Corporations)

FEES (Filing and Disclosure): $25.00.
If this is an amendment, see instructions.

FILED

IMPORTANT – READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

In the office of the Secretary of State
of the State of California

1. CORPORATE NAME

PRIZM JANITORIAL SERVICES, INC.

MAY-05 2016

2. CALIFORNIA CORPORATE NUMBER
This Space for Filing Use Only

C3119686
No Change Statement (Not applicable if agent address of record is a P.O. Box address. See instructions.)

If there have been any changes to the information contained in the last Statement of Information filed with the California Secretary
of State, or no statement of information has been previously filed, this form must be completed in its entirety.
If there has been no change in any of the information contained in the last Statement of Information filed with the California Secretary
of State, check the box and proceed to Item 17.

3.

Complete Addresses for the Following (Do not abbreviate the name of the city. Items 4 and 5 cannot be P.O. Boxes.)
4.

STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE

CITY

STATE

ZIP CODE

555 COUNTRY CLUB LANE # C-196, ESCONDIDO, CA 92026
5.

STREET ADDRESS OF PRINCIPAL BUSINESS OFFICE IN CALIFORNIA, IF ANY

CITY

STATE

ZIP CODE

6.

MAILING ADDRESS OF CORPORATION, IF DIFFERENT THAN ITEM 4

CITY

STATE

ZIP CODE

7.

EMAIL ADDRESS FOR RECEIVING STATUTORY NOTIFICATIONS

Names and Complete Addresses of the Following Officers (The corporation must list these three officers. A comparable title for the specific
officer may be added; however, the preprinted titles on this form must not be altered.)
7.

CHIEF EXECUTIVE OFFICER/

JOHNSON LE
8.

SECRETARY

ADDRESS

TRINH THI NGUYEN
9.

ADDRESS

CITY

STATE

ZIP CODE

CITY

STATE

ZIP CODE

STATE

ZIP CODE

555 COUNTRY CLUB LANE #C-196, ESCONDIDO, CA 92026

555 COUNTRY CLUB LANE # C-196, ESCONDIDO, CA 92026

CHIEF FINANCIAL OFFICER/

JOHNSON LE

ADDRESS

CITY

555 COUNTRY CLUB LANE #C-196, ESCONDIDO, CA 92026

Names and Complete Addresses of All Directors, Including Directors Who are Also Officers (The corporation must have at least one
director. Attach additional pages, if necessary.)
10. NAME

ADDRESS

JOHNSON LE

CITY

STATE

ZIP CODE

555 COUNTRY CLUB LANE C-196, ESCONDIDO, CA 92026

11. NAME

ADDRESS

CITY

STATE

ZIP CODE

12. NAME

ADDRESS

CITY

STATE

ZIP CODE

13. NUMBER OF VACANCIES ON THE BOARD OF DIRECTORS, IF ANY:

Agent for Service of Process If the agent is an individual, the agent must reside in California and Item 15 must be completed with a California street
address, a P.O. Box address is not acceptable. If the agent is another corporation, the agent must have on file with the California Secretary of State a
certificate pursuant to California Corporations Code section 1505 and Item 15 must be left blank.
14. NAME OF AGENT FOR SERVICE OF PROCESS

JOHNSON LE
15. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL CITY

STATE

ZIP CODE

555 COUNTRY CLUB LANE # C-196, ESCONDIDO, CA 92026
Type of Business
16. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION

JANITORIAL SERVICES

17. BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE CALIFORNIA SECRETARY OF STATE, THE CORPORATION CERTIFIES THE INFORMATION
CONTAINED HEREIN, INCLUDING ANY ATTACHMENTS, IS TRUE AND CORRECT.

05/05/2016
DATE
SI-200 (REV 01/2013)

CEO

JOHNSON LE
TYPE/PRINT NAME OF PERSON COMPLETING FORM

Page 1 of 1

TITLE

SIGNATURE
APPROVED BY SECRETARY OF STATE