700: Nickerson - 2016 from 01/01 to 12/31CALIFORNIA FORM 700
PUBLIC DO=UNIENT
Please type or print in Ink
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
1s
RECEIVED
to InitjJl EL'ttg2+4c2
OKfaal Use Onry
CITY OF LA QUINTA
CITY CLERK DEPARTMENT
NAME OF FILER (LAST)
Nickerson, Jr.
(H)
Lloyd
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
Contract Project Manager
Your Position
► If filing for multiple positlons, list below or on an attachment. (Do not use acronyms)
Agency:
Position.
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
❑x city of La Quinta
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
x❑ Annual: The period covered is January 1, 2016, through ❑ Leaving Office: Date Left If
December 31, ZI715, (Ghesx one)
-or-
The period covered is , through
December 31, 2016.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
p The period covered is January 1, 2016, through the date of
leaving office.
-or-
o The period covered is _J_1 , through
the date of leaving office.
and office sought, if different than Part 1
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
❑ Schedule A-1 - investments — schedule attached
❑x Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Properly — schedule attached
-or-
El None - No reportable interests on any schedule
❑x Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
0 Schedule E - Income — Gifts — Travel Payments — schedule attached
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
68-955 Adelina Road
CITY
Cathedral City
STATE ZIP CODE
CA 92234
DAYTIME TELFPIION€ NUTAOER
( 760 ) 323-5344
EMAIL ADDRESS
n nicke rson@ n aico n s u I ting.com
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and co
Date Signed rel. (41 j_� 11 Signature css't kk
(menfat day, year) (Re eeipaa fyeteedslalsmed NO purging )
FPPC Form 700 (2016/2017)
FPPC Advice Email: advlce@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
NAI Consulting, Inc.
Name
68-955 Adelina Road, Cathedral City, CA 92234
Address (Business Address Acceptable)
Check one
0 Trust, go to 2 ❑x Business Entity, complete the box, then go fo 2
GENERAL DESCRIPTION OF THIS BUSINESS
Civil Engineering Firm
FAIR MARKET VALUE
❑ 50 - 51,999
9 52,000 - 510,000
❑ 510,001 - $100,000
❑ sioo,001 - si.000,000
X❑ Over 51,000,000
IF APPLICABLE, UST DATE:
_. /. _. 1. 16 / / 16
ACQUIRED DISPOSED
NATURE OF INVESTMENT
9 Partnership ❑ Sole Proprietorship
YOUR BUSINESS POSITION President
S -Corp
Other
I. 2. IDENTIFY THE GROSS INCOME RECEIVED !INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME ] THE ENTITY(TRUST)
I.1 $0 - 5499
[11 $500 - 51,000
❑ stool - 510,000
❑ sio,001 - si00,000
❑X OVER 5100,000
► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF 510,000 OR MORE •aii,:,r s _ .. s . .r "i, ss„y,
LJ None or ® Names listed below
City of La Quints
P. 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED ER. THE BUSINESS ENTITY OR TRUST
Check one box:
9 INVESTMENT
9 REAL PROPERTY
Name of Business Entity, if Investment, gt
Assessor's Parcel Number or Street Address of Real Properly
Description of Business Activity gt
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, UST DATE:
9 $2,000 - 510,000
❑ sio.001 - sioo,o00
❑ 5100,001 - 51,000,000
9 Over $1,000,000
NATURE OF INTEREST
9 Property Ownership/Deed of Trust 9 Stock 9 Partnership
16 ) 16
ACQUIRED DISPOSED
9 Leasehold _ ❑ Other
, eurni r+10
9 Check box if additional schedules reporting investments or real property
are attached
Comments:
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES cor,WISSION
Name
Lloyd Nickerson, Jr,
► 1, BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
0 Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
50 - 51,999
32,000 - 510,000
9 510,001 - 5100,000
0 5100,001 - 51,000,000
❑ Over 51,000,000
IF APPLICABLE, UST DATE:
_j_/16 L /16
ACQUIRED DISPOSED
NATURE OF INVESTMENT
U Partnership 9 Sole Proprietorship ❑
YOUR BUSINESS POSITION
Other
► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA.
SHARE OF THE GROSS INCOME ID THE ENTITY/TRUST)
❑ 50 - $499
0 $500 - 51,000
❑ 51,001 - 510,000
❑ $10,001 - $100,000
9 OVER 5100,000
P. ?. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10.000 OR MORE ..,,•sem _ .r,.�-, , .:..�
None or Names listed below
► 4 INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED Ea THE BUSINESS ENTITY OR TRUST
Check one box:
9 INVESTMENT
9 REAL PROPERTY
Nadia of Business Entity, if Investment, et
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity et
City or Other Precise Location of Real Properly
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
52,000 - $10,000
310,001 - $100,000
5100,001 - 51,000,000
0 Over 51,000,000
NATURE OF INTEREST
9 Property Ownership/Deed of Trust 9 Stock ❑ Partnership
/ / 16 / / 16
ACQUIRED DISPOSED
❑ Leasehold -----._-_ - ❑ Other --- _
0411.1,11,4 I Li
❑ Chock box if additional schedules reporting investments or real property
I are Attached
FPPC Form 700 (2016/2017) Sch. A-2
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
► 1, INCOME RECEIVED
NAME OF SOURCE OF INCOME
NAI Consulting, Inc.
ADDRESS (Business Address Acceptable)
68-955 Adelina Road, Cathedral City, CA 92234
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Civil Engineering Firm
YOUR BUSINESS POSITION
President
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - 51,000 0 51,001 - 510,000
❑ $10,001 - $100,000 ❑X OVER 1100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
X❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of 510,000 or mom
(Real property, eer, boat, eft.)
❑ Other
(Describe)
(Describe)
1, INCOME RECEIVED
CALIFORNIA FORM 700
FAIR POLITICAL PRACFICEL COr.9P,ussIor:
Name
Uoyd Nickerson, Jr.
NAME OF SOURCE OF INCOME
State Board of Equalization
ADDRESS (Business Address Acceptable)
3737 Main St., Ste. 1000, Riverside, CA 92501
BUSINESS ACTIVITY, IF ANY, OF SOURCE
State Agency
YOUR BUSINESS POSITION
Spouse of Tax Auditor
GROSS INCOME RECEIVED
❑ $500 - 51,000
❑ $10,001 - $100,000
❑ No Income - Business Position Only
❑ 51,001 - $10,000
❑x OVER 5100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ['Spouse's or registered domestic partner's income
(For sell•employad use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
❑ Loan repayment
0 Commission or
0 Other
(Real properly, car, boat, etc)
❑ Rental Income, list each source of 510,000 or more
(Describe)
(Describe)
P. 2, LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER"
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
0 $500 - 51,000
❑ $1.00l - $10,000
❑ $10,001 - 5100,000
❑ OVER 5100,000
Comments:
INTEREST RATE TERM (MonlhslYears)
% 0 None
SECURITY FOR LOAN
❑ None
❑ Real Property
❑ Guarantor
❑ Other
0 Personal residence
Sheol address
City
(Describe)
FPPC Form 700 (2016/2017) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov