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700: Nickerson - 2015 from 01/01 to 12/31CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT Please type or print in ink. NAME OF FILER (LAST) Nickerson, Jr. 1. Office, Agency, or Court STATEMENT OF ECONOMIC INT E �` ��_ '�IolacialUse Only Received OFFICE COVER PAGE (FIRST) Lloyd 2016 MAR 16 PM 7:.a (MIDDLE) CITY OF 1 AMANTA Agency Name (Do not use acronyms) City of La Quinta Contract Project Manager Division, Board, Department, District, if applicable Your Position ► 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 ©City of La Quinta ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other 3. Type of Statement (Check at feast one box) © Annual: The period covered is January 1, 2015, through ❑ Leaving Office: Date Left _/_/ December 31, 2015. (Check one) -or- The period covered is —J—J through December 31, 2015. ❑ Assuming Office: Date assumed O The period covered is January 1, 2015, through the date of leaving office. -or- O The period covered is _J—_J , through the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1• 4. ,Schedule Summary (must complete); ► Total number of pages including this cover..page:i Schedules ,attached ❑ Schedule, A-1 - Investments schedule attached . WI Schedule 'A-2, • Investments – schedule attached ' - ❑ Schedule B.- Real Property–.schedule attached -or • ❑ -None:- No reportable interests on any schedule Schedule C - Income, Loans, & Business Positions – schedule attached ❑ Schedule D - Income – Gifts = schedule attached ❑.Schedule E - Income – Gifts – Travel_ Payments - schedule attached.. , 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - Public Document) 68-955 Adelina Road CITY Cathedral City STATE ZIP CODE CA 92234 DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS ( 760 ) 323-5344 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 foregoing is true and correRt. Date Signed C Y \ o_r ck\ p,ao1 Signature (month, day, year) (File ; originally signed statement with your filing official.) FPPC Form 700 (2015/2016) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE A-2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) ► 1. BUSINESS ENTITY OR TRUST NAI Consulting, Inc. Name 68-955 Adelina Road, Cathedral City, CA 92234 Address (Business Address Acceptable) Check one 0 Trust, go to 2 IZI Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS Professional Engineering Services FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $0 - $1,999 • $2,000 - $10,000 / / 15 15 _/_/ • 510,001 - $100,000 ACQUIRED DISPOSED t2 $100,001 - $1,000,000 • Over $1,000,000 NATURE OF INVESTMENT S -Corp • Partnership • Sole Proprietorship n Other YOUR BUSINESS POSITION President 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME ZQ THE ENTITY/TRUST) • $0 - $499 • $10,001 - $100,000 • $500 - $1,000 • OVER $100,000 • $1,001 - $10,000 P. 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TQ THE ENTITY/TRUST) • $0 - $499 • $10,001 - $100,000 • $500 - $1,000 IJ OVER $100,000 • $1,001 - $10,000 ► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet it necessary.) • None or I4 Names listed below City of La Quinta 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED @y THE BUSINESS ENTITY OR TRUST Check one box: • INVESTMENT • REAL PROPERTY O. 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED @Y THE BUSINESS ENTITY OR TRUST Check one box: • INVESTMENT • REAL PROPERTY Name of Business Entity, if Investment, pi Assessor's Parcel Number or Street Address of Real Property Description of Business Activity g[ City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $2,000 - $10,000 • $10,001 - $100,000 _/_/ 15 / / 15 • $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 CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Lloyd Nickerson, Jr. 1. BUSINESS ENTITY OR TRUST Name Address (Business Address Acceptable) Check one 0 Trust, go to 2 0 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 1. / 15 15 ,_/___/ • $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 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME ZQ THE ENTITY/TRUST) • $0 - $499 • $10,001 - $100,000 • $500 - $1,000 • OVER $100,000 • $1,001 - $10,000 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet it necessary.) • None or • Names listed below 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED @y THE BUSINESS ENTITY OR TRUST Check one box: • INVESTMENT • REAL PROPERTY Name of Business Entity, if Investment, 4[ Assessor's Parcel Number or Street Address of Real Property Description of Business Activity g1 City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $2,000 - $10,000 • 510,001 - $100,000 /_/ 15 / / 15 • $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' FPPC Form 700 (2015/2016) Sch. A-2 FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) ► 1. INCOME RECEIVED 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 Municipal Engineering Firm YOUR BUSINESS POSITION President GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $10,001 - $1oo,000 ❑ $1,001 - $10,000 © 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 ❑ Other (Describe) $ 1. INCOME RECEIVED CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Lloyd Nickerson, Jr. NAME OF SOURCE OF INCOME State Board of Equalization ADDRESS (Business Address Acceptable) 3737 Main St, Ste. 1000, Riverside, CA 92501 BUSINESS ACTIVITY, IF ANY, OF SOURCE State Agency YOUR BUSINESS POSITION Spouse of Tax Auditor GROSS INCOME RECEIVED ❑ $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 (Describe) (Describe) ► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD * You are not required to report loans from commercial lending institutions, 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 INTEREST RATE TERM (Months/Years) ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street address City ❑ Guarantor ❑ Other (Describe) Comments' FPPC Form 700 (2015/2016) Sch. C FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov