700 NAI Consulting (Nickerson, L) 2020STATEMENT OF ECONOMIC INTE
COVER PAGE
A PUBLIC DOCUMENT
Please type or print in ink.
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
RECEIVED
Date Initial Filing
MARI,npo TIJ/ I
CITY OF LA QUINITA
CITY CLERK DEPARTMENT
Contract Project Manager
► 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
❑■ City of La Quinta
3. Type of Statement (Check at least one box)
111; Annual: The period covered is January 1, 2020, through
December 31, 2020.
.or -
The period covered is I I through
December 31, 2020.
❑ Assuming Office: Date assumed —1—1
❑ Candidate: Date of Election
Schedule Summary (must complete)
Schedules attached
Position:
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left 1 —.I _
(Check one circle.)
O The period covered is January 1, 2020, through the date of
-or-
leaving office.
O The period covered is I I through
the date of leaving office.
and office sought, if different than Part 1:
► Total number of pages including this cover page:
❑ 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
X 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 C;TY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 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
Date Signed 02/22/2021
(month, day, year)
Signature
Me
W&I yOUF WIng Ofrl679 )
FPPC Form 700 - Cover Page (2020/2021)
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)
0- 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 siness 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 --j--j20 --j--j20
❑ $10,001 - $100-000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
Over $1,000.000
NATURE OF INVESTMENT S-Cor
❑ Partnership ❑ Sole Proprietorship ❑ p
Other
YOUR BUSINESS POSITION President
SHARE OF •SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 OVER $100,000
❑ $1,001 - $10,000
103. LIST THE NAME OF ••RTABLE SINGLE SOURCE OF
INCOMEOF $10,000 OR MORE
❑ None or K Names listed below
City of La Quinta
PROPERTY1� 4. INVESTMENTS AND INTERESTS IN REAL ..
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 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 /20 --J--J20
L] $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
LloydName
Nickerson, Jr.
10- 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 /20
❑ $10-00, - $100,000 ACQUIRED DISPOSED
$100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
IDENTIFY• • . (INCLUDE YOUR-• RATA
SHARE OF •SS INCOME TO THE ENTITYITRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1.00, - $10,000
1� 3. LIST THE NAME OF •RTABLE SINGLE SOURCE OF
INCOMEOF $10,000 OR •-
❑ None or ❑ Names listed below
m- 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY ..
LEASED BY THE BUSINESS ENTITY OTRUST
R
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
L7 $10,001 - $100,000 /20 --j--j29
$100,001 - $1,000.000 ACQUIRED DISPOSED
❑ Over $1,000.000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 - Schedule A-2 (2020/2021)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 9
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 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 ICI OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Q 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)
Name
Lloyd Nickerson, Jr.
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 Retired State Employee
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1.000 ❑ $1,001 - $10,000
o $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
(Describe)
Other Retirement Income
(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 (MonthsiYears)
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
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700 - Schedule C (2020/2021)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13