0001171843-17-005034.txt : 20170814
0001171843-17-005034.hdr.sgml : 20170814
20170814144045
ACCESSION NUMBER: 0001171843-17-005034
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170609
FILED AS OF DATE: 20170814
DATE AS OF CHANGE: 20170814
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Monfort Edward R.
CENTRAL INDEX KEY: 0001712532
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38078
FILM NUMBER: 171029390
MAIL ADDRESS:
STREET 1: 620 NEWPORT CENTER DRIVE, SUITE 1100
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ADOMANI, INC.
CENTRAL INDEX KEY: 0001563568
STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLE PARTS & ACCESSORIES [3714]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 620 NEWPORT CENTER DRIVE
STREET 2: SUITE 1100
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
BUSINESS PHONE: (949) 200-4613
MAIL ADDRESS:
STREET 1: 620 NEWPORT CENTER DRIVE
STREET 2: SUITE 1100
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
FORMER COMPANY:
FORMER CONFORMED NAME: Adomani, Inc.
DATE OF NAME CHANGE: 20121203
3
1
formthree.xml
OWNERSHIP DOCUMENT
X0206
3
2017-06-09
0
0001563568
ADOMANI, INC.
ADOM
0001712532
Monfort Edward R.
2850 TOBAGO PLACE
COSTA MESA
CA
92626
0
1
1
0
Chief Technology Officer
Common Stock
4000000
I
By trust
Stock Option (Right to Buy)
0.10
2020-11-01
Common Stock
12000000
D
Stock Option (Right to Buy)
0.10
2022-06-01
Common Stock
3000000
D
These shares are owned directly by the Monfort Revocable Living Trust, Dated 8/19/16, and indirectly by Edward R. Monfort as trustee of the trust. Edward R. Monfort is an officer and a ten percent owner of the issuer.
The option vests in equal monthly installments of 1/60 of the total number of shares underlying the option beginning on November 1, 2012.
The option vests in equal monthly installments of 1/60 of the total number of shares underlying the option beginning on June 1, 2014.
/s/ Edward R. Monfort
2017-08-10