700: Nickerson, L - 2017 from 01/01 to 12/31STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST)
Nickerson, Jr. Lloyd
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta Contract Project Manager
Division, Board, Department, District, if applicable Your Position
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (check at feast one box)
❑ State
❑ Multi -County
FW City of La Quinta
3. Type of Statement (check at least one box)
iss] Annual: The period covered is January 1, 2017, through
December 31, 2017.
-or-
The period covered is J�
December 31, 2017.
❑ Assuming Office: Date assumed I
❑ Candidate: Date of Election
RECEIVED
Date Initial Filing Received
MI Use T12O1p
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
(MIDDLE)
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left I
(Check one)
through O The period covered is January 1, 2017, through the date of
leaving office.
.or -
0 The period covered is ----- I 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: • of
Schedules attached
❑ Schedule A-1 - Investments — schedule attached ❑■ Schedule C - Income, Loans, & Business Positions — schedule attached
# Schedule A-2 - Investments — schedule attached ❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule B - Real Property — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
.or -
El None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
68-955 Adelina Road Cathedral City CA 92234
DAY110,c TELEPHONE NUMBERE-MAILADDRESS
�6a 7323-5344 nnickerson@naiconsulting.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 andorrect./)
Date Signed V -7T_ Signature
(month, day, year) (F earonaflysonedslalamanf with your filing official.)
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-2 ---ALIFORNIA FORM1 1
Investments, Income, and Assets 7AIR POLITICAL PRACTICES COMMISSION
of Business Entities/Trusts
Name
(Ownership Interest is 10% or Greater)1. BUSINESS ENTITY OR TRUST
Lloyd Nickerson, Jr
Address (Business Address Acceptable)
Check one
Ll Trust. go to 2 El Business Entity, complete the box, then go to 2
11111 1. BUSINESS ENTITY OR TRUST
NAI Consulting, Inc.
Name
68-955 Adelina Road, Cathedral City, CA 92234
Address (Business Address Acceptable)
Check one
[I Trust, go to 2 141 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
Civil Engineering Firm
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 -/�7 � , 17
F-1$10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
lei Over $1,000,000
NATURE OF INVESTMENT
❑ ❑ i _
Si:Or
Partnership Sole Proprietorship
� p
YOUR BUSINESS POSITION President
• e-• • r • .. •.- •-•
• -• • • THE ENTITY/TRUST)
❑
$0-$499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑■ OVER $100,000
El $1,001 - $10,000
❑ None or [i] Names listed below
City of La Quinta
LEASED OR TRUST
Check one box.
[-]INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Invesunew, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
$2,000 - $10,000
$10,001 - $100,000
___/� �7 �� 17
$100,001 - $1,000,000
ACQUIRED DISPOSED
Over $1,000,000
NATURE OF INTEREST
E] Property Ownership/Deed of Trust
❑ Stock ❑ Partnership
❑ Leasehold F-1Other
Yrs remaining
F] Check box if additional schedules reporting investments or real property
are attached
Comments
Name
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
so -$1,999
[-1$2,000 - $10,000 /17 �� 77
$10,001 - $100,000 ACQUIRED DISPOSED
J $100,001 - $1,oao,000
-J over $1,000,000
NATURE OF INVESTMENT
[:]Part
nership ❑Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
❑
$0- $ass ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑OVER $100,000
fJ $1,001 - $10,000
INCOME OF $10,000 OR MORE
nNone or FT -
Names listed below
in AEAw-1L&#P-Eek-rT-rrEiF21 IIA
LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box:
[-]INVESTMENT ❑REAL
PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Propert
ached
y
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
F-]$2,000 - $10,000
❑ $10,001 - $,00,000 17 --J--j-17
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust F] Stock ❑Part
nership
❑ Leasehold F] Other
Yrs remaining
❑ Check box if additional schedules reporting investments or real property
are att
FPPC Form 700 (2017/2018) 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)
NAME OF SOURCE OF INCOME
NAI Consulting, Inc.
ADDRESS (Business Address Acceptable)
68-955 Adelina Rd, 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 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 iJ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Irk 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
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
Name
Lloyd 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 ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 [11I OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary Cif 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
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
* 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
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (MonthsNears)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
city
❑ Guarantor
❑ Other
(Describe)
FPPC Form 700 (2017/2018) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov