700 Ambriz 2019 Leaving Office 06/21/2019STATEMENT OF ECONOMIC INTERESTS RECEIvEplved
COMMISSIONFAIR POLITICAL PRACTICES COVER PAGE NOV 2 2 2019
Please type or print in ink. A PUBLIC DOCUMENT CITY OF LA ouwTA
NAME OF FILER (LAST) (FIRST) { QEi r F-PARTMENT
Ambriz, Jr. Robert
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
Facilities Department, Parks Division
Your Position
Parks Superintendent
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
❑x City of La Quinta
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
n (.minty of
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2018, through ❑x Leaving Office: Date Left 06 1 21 i 2019
-or-
December 31, 2018. (Check one circle.)
The period covered is through 0 The period covered is January 1, 2018, through the date of
December 31, 2018. -or- leaving office.
❑ Assuming Office: Date assumed Q The period covered is I I through
the date of leaving office.
❑ Candidate: Date of Election and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page: 1
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- x❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
78495 Calle Tampico
DAYTIME TELEPHONE NUMBER
( 760 ) 777-7091
La Quinta
STATE ZIP CODE
CA 92253
EMAIL ADDRESS
rambrizj@laquintaca.gov
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 correct.
Date Signed 11-22-19
(month, day, year)
Signature_
(File the statement with your filing official.)
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 5