700 Nickerson, L (NAI) 2019 from 01/01 to 12/31STATEMENT OF ECONOMIC INTERESTS
RECEWED
- COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
41
CITY OF LA QUINTA
CITY CLERIC DEPARTMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Nickerson, Jr. Lloyd
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable Your Position
Contract Project Manager
► If filing for multiple positions, 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
3. Type of Statement (Check at least one box)
❑ Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
n County of
❑ Other
x❑ Annual: The period covered is January 1, 2019, through ❑ Leaving Office: Date Left I I
-or-
December 31, 2019. (Check one circle.)
The period covered is I I through O The period covered is January 1, 2019, through the date of
December 31, 2019. -or-
leaving office.
❑ Assuming Office: Date assumed I 1 O The period covered is =J ----- J, through
the date of leaving office.
❑ Candidate: Date of Election and office sought, if different than Part 1
4. Schedule Summary (must complete) o. Total number of pages including this cover page: 3
Schedules attached
❑ Schedule A-1 - Investments — schedule attached 0 Schedule C - Income, Loans, & Business Positions — schedule attached
❑x 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- ❑ Node - No reportable interests on any schedule
5. Verification
MAILING ADDRESS SiREEI CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
68-955 Adelina Rd Cathedral City CA 92234
DAYTIME TELEPHONE NUMBER Tnn
ADDRESS
( 760 ) 323-5344 kerson@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 JQrepoinq is true and correct.
—L
f� {
Date Signed �"i r a-C) a." Signature
(m h, day, ye) (File the ortg lly signed paperstatement with your filing official.)
FPPC Form 700 - Cover Page (2029/2020)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
Page - 5
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
Ip 1. BUSINESS ENTITY OR TRUST
NAI Consulting, Inc.
Name
68-955 Adelina Road, Cathedral City, CA 92234
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ 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
❑ $10.001 - $100.000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑X Over $1,000,000
NATURE OF INVESTMENT S-Cor
❑ Partnership ❑ Sole Proprietorship ❑X p
Other
YOUR BUSINESS POSITION President
V=j1`n%-r(rf-r-• • ■ ■ ■ •
SHARE OF •SS INCOME TO THE ENTITYITRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑X OVER $100,000
❑ $1,001 - $10,000
1� 3. LIST THE NAME OF ••RTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sh-1 if iceessary.)
❑ None or ❑X Names listed below
City of La Quinta
0- 4. INVESTMENTS ■ INTERESTS IN REAL PROPERTY■ OR
LEASED BY THE BUSINESS ENTITY OR
Check one box;
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, 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
. $100,001 - $1,000,000 ACQUIRED DISPOSED
Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
1��5. remalning
❑ Check box if addifional schedules reporting investments or real property
are attached
Com
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
11- 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE
❑ $0 - $1,999
❑ $2,000 - $10,000
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100.001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
P- 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF •SS INCOME TO THE ENTITYITRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
1� 3. LIST THE NAME OF ••TABLE SIN61-E. SOURCE OF
INCOMEOF $10,000 OR •
❑ None or 0 Names listed below
• INTERESTS IN REAL PROPERTY• OR
LEASED BY THE BUSINESS ENTITY • TRUST
-
Check one box.,
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity Q
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
Fj $10,00, - $100,000 19 --J--J19
r $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold re Yr, ❑ Other
s_ marsing
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 -Schedule A-2(201912020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 9
SCHEDULE C • - • -
Income, Loans, & Business '
Positions Name
(Other than Gifts and Travel Payments) Lloyd Nickerson, Jr.
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 - $1,000 ❑ $1,001 - $10.000
❑ $10,001 - $100,000 ❑X OVER $100,000
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
❑ Other
(Real property, car, boat, etc)
❑ Rental Income, list each source of $10,000 or more
(Describe)
(Describe)
NAME OF SOURCE OF INCOME
California Department of Tax and Fee Administration
ADDRESS (Business Address Acceptable)
3737 Main Street, Ste. 1000, Riverside, CA 92501
BUSINESS ACTIVITY. IF ANY. OF SOURCE
State Agency
YOUR BUSINESS POSITION
Spouse of District Principal Auditor
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10.001 - $100,000 ❑X OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑X 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
❑ Other
(Describe)
(Describe)
* You are not required to report loans from a commercial lending institution, 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
❑ Guarantor
❑ Other
Street address
city
(Describe)
FPPC Form 700 - Schedule C (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13