700 Dudek (Nickerson) 2020RECEIVED
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
A PUBLIC DOCUMENT
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Nickerson Audrey Gale
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
Dudek
Division, Board, Department, District, if applicable
Planner
Your Position
Consultant
► 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
Iy] City of La Quinta
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2020, through
December 31, 2020.
-or-
The period covered is
December 31, 2020.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
Date IInf
nju�ioall Filing
}Received
CITY OF LA QUINTA
CITY CLERK DEPARTMENT
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left I I
(Check one circle.)
through O The period covered is January 1, 2020, through the date of
leaving office.
.or-
0 The period covered is I I through
the date of leaving office.
and office sought, if different than Part 1
Schedule Summary (must complete) ► Total number of pages including this cover page: 2
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or- ❑ None - No reportable interests on any schedule
5. Verification
❑■ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
78-075 Main Street, Suite G-203 La Quinta CA 92253
DAYTIME TELEPHONE NUMBER EMAILADDRESS
( anickerson@dudek.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 correct.
Date Signed March 8, 2021 Signature _ �
(month, day, year) (File fhe&§maflysrgped paper slatemenl with your filing official)
FPPC Form 700 - Cover Page (2020/2021)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
Page - 5
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
NAI Consulting, Inc.
ADDRESS (Business Address Acceptable)
68955 Adelina Road, Cathedral City, CA 92234
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Engineering
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $10o,000 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary iX- 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 or $10,000 or more
❑ Other
(Describe)
(Describe)
Name
Nickerson, Audrey
NAME OF SOURCE OF INCOME
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10.001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ 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
❑ 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' INTEREST RATE TERM (MonthsNears)
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:
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
❑ Guarantor
❑ Other
city
(Describe)
FPPC Form 700 -Schedule C12020/2021)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13