`Case 2:22-cv-01776-WSH Document 29-13 Filed 07/20/23 Page 1 of 3
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`EXHIBIT M
`EXHIBIT M
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`Case 2:22-cv-01776-WSH Document 29-13 Filed 07/20/23 Page 2 of 3
`LLC-12
`Secretary of State
`Statement of Information
`(Limited Liability Company)
`
`IMPORTANT — This form can be filed online at
`bizfile.sos.ca.gov.
`Read instructions before completing this form.
`Filing Fee - $20.00
`Copy Fees - First page $1.00; each attachment page $0.50;
`Certification Fee - $5.00 plus copy fees
`
`This Space For Office Use Only
`1. Limited Liability Company Name (Enter the exact name of the LLC. If you registered in California using an
`alternate name, see instructions.)
`
`2. 12-Digit Secretary of State Entity Number
`
`3. State, Foreign Country or Place of Organization (only
`if formed outside of California)
`
`4. Business Addresses
`a. Street Address of Principal Office - Do not list a P.O. Box
`
`City (no abbreviations)
`
`State Zip Code
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`b. Mailing Address of LLC, if different than item 4a
`
`City (no abbreviations)
`
`State Zip Code
`
`c. Street Address of California Office, if Item 4a is not in California
`Do not list a P.O. Box
`
`City (no abbreviations)
`
`State
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`CA
`
`Zip Code
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`5. Manager(s) or Member(s)
`
`If no managers have been appointed or elected, provide the name and address of
`each member. At least one name and address must be listed. If the
`manager/member is an individual, complete Items 5a and 5c (leave Item 5b blank).
`If the manager/member is an additional managers/members, enter the names(s)
`and address(es) on Form LLC-12A.
`a. First Name, if an individual - Do not complete Item 5b
`Middle Name
`
`Last Name
`
`Suffix
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`b. Entity Name - Do not complete Item 5a
`
`c. Address
`
`City (no abbreviations)
`
`State Zip Code
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`LLC-12 (REV 12/2021)
`
`2021 California Secretary of State
`bizfile.sos.ca.gov
`
`22-A75968
`
`FILED
`
`In the office of the Secretary of State
` of the State of California
`
`FEB 02, 2022
`
`DOORDASH ESSENTIALS, LLC
`
`201930410037
`
`DELAWARE
`
`303 2ND STREET, SOUTH TOWER, 8TH FLOOR
`
`SAN FRANCISCO
`
`CA
`
`94107
`
`303 2ND STREET, SOUTH TOWER, 8TH FLOOR
`
`SAN FRANCISCO
`
`CA
`
`94107
`
`TONY
`
`XU
`
`303 2ND STREET, SOUTH TOWER, 8TH FLOOR
`
`SAN FRANCISCO
`
`CA
`
`94107
`
`Page 1 of 2
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`
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`Case 2:22-cv-01776-WSH Document 29-13 Filed 07/20/23 Page 3 of 3
`6. Service of Process (Must provide either Individual OR Corporation.)
`INDIVIDUAL – Complete Items 6a and 6b only. Must include agent’s full name and California street address.
`
`a. California Agent's First Name (if agent is not a corporation) Middle Name
`
`Last Name
`
`Suffix
`
`b. Street Address (if agent is not a corporation) - Do not enter a
`P.O. Box
`
`City (no abbreviations)
`
`State
`
`Zip Code
`
`CA
`
`CORPORATION – Complete Item 6c only. Only include the name of the registered agent Corporation.
`c. California Registered Corporate Agent’s Name (if agent is a corporation) – Do not complete Item 6a or 6b
`
`7. Type of Business
`Describe the type of business or services of the Limited Liability Company
`
`8. Chief Executive Officer, if elected or appointed
`a. First Name
`
`Middle Name
`
`Last Name
`
`Suffix
`
`b. Address
`
`City (no abbreviations)
`
`State Zip Code
`
`9. Labor Judgment
`
`Does a Manager or Member have an outstanding final judgment issued by the Division
`of Labor Standards Enforcement or a court of law, for which no appeal therefrom is
`pending, for the violation of any wage order or provision of the Labor Code?
`
`Yes
`
`No
`
`10. By signing, I affirm under penalty of perjury that the information herein is true and correct and that I am
`authorized by California law to sign.
`
`_____________________
`Date
`
` ____________________________________________________________
`Type or Print Name
`
`________________________
`Title
`
` __________________________________
`Signature
`
`LLC-12 (REV 12/2021)
`
`
`
`2021 California Secretary of State
`bizfile.sos.ca.gov
`
`C T CORPORATION SYSTEM (C0168406)
`
`ONLINE MARKETPLACE
`
`4
`
`02/02/2022
`
`JOE DAVIS
`
`AUTH. PERSON
`
`Page 2 of 2
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