700 NV5 (Fahrion) 2020DocuSign Envelope ID: E75AE1 BE-07C9-4B63-AO23-C9C639027AA2 RECEIVED
STATEMENT OF ECONOMIC INTERESTS Date Initial Filing F
CALIFORNIA • - ' ' = ig 0, al Use ,
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE W1, R 0 8 2021
A PUBLIC DOCUMENT
Please type or print in ink.
CITY OF LA Qi11NTA
CITY CLERIC DEPARTMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Fahrion Jay S
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
NV5, Inc.
Division, Board, Department, District, if applicable
Your Position
Consultant
P. 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
-01 City of La Quinta
3. Type of Statement (Check at least one box)
0 Annual: The period covered is January 1, 2020, through
December 31, 2020.
.or-
The period covered is I through
December 31, 2020.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
Position:
❑ Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left I .
(Check one circle.)
O The period covered is January 1, 2020, through the date of
leaving office.
.or-
0 The period covered is 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:
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)
42-829 Cook Street, Suite 104
DAYTIME TFIEPHDNE NUMBER
(
CITY STATE ZIP CODE
Palm Desert CA 92211
EMAIL ADDRESS
jay.fahrion@nv5.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 aq co�eCt.
3/5/2021 �
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FPPC Form 700 -Cover Page(2020/2021)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
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