700 NV5 (Fahrion) 2023DocuSign Envelope ID: 64F99C78-64AA-4DEl-BAFD-OBB677B4AEEF
CALIFORNIA FORm7OO STATEMENT OF ECONOMIC INTERESTS
COMMISSIONFAIR POLITICAL PRACTICES COVER PAGE
A PUBLIC DOCUMENT
Date Initial Filing Received
Filing Official Use Only
RECEIVED
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
FAHRION JAY S APR 0 2 ZO^
1. Office, Agency, or Court CITY OF LA QUINTA
GFrY ni cost DEPA ENT
Agency Name (Do not use acronyms)
NV5,INC.
Division, Board, Department, District, if applicable 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 Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
Multi -County _ County of
■ City of LA OUINTA Other
3. Type of Statement (Check at least one box)
■ Annual: The period covered is January 1, 2023, through Leaving Office: Date Left I I
December 31, 2023. (Check one circle.)
-or- The period covered is January 1, 2023, through the date
The period covered is �—� ,through p y g
December 31, 2023. -or- of leaving office.
Assuming Office: Date assumed I I The period covered is I I through
the date of leaving office.
Candidate: Date of Election and office sought, if different than Part 1:
Schedule Summary (required) ► 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- ■ 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
CITY
PALM DESERT
EMAIL ADDRE
( 760 ) 341-3101 1 iay.fahrion nv5.com
STATE ZIP CODE
CA 92211
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.
r—DocuSigned by:
Date Signed 4/02/2024 Signature
(month, day year]
paper statement with your
FPPC Form 700 -Cover Page (2023/2024)
advice@fppc.ca.gov • 866-275-3772 - www.fppc.ca.gov
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