Loading...
2016 Caha, Becky Amendment 2 - Affordable Housing Monitoring & ComplianceAMENDMENT NO. 2 TO PROFESSIONAL SERVICES AGREEMENT WITH BECKY CAHA This Amendment No. 2 to Professional Services Agreement with Becky Caha ("Amendment No. 2") is made and entered into as of the (5t -day of March 2016 ("Effective Date") by and between the CITY OF LA QUINTA ("City"), a California municipal corporation, LA QUINTA HOUSING AUTHORITY, a public body, corporate and politic, (together: "City/Authority") and Becky Caha, sole proprietor and independent contractor ("Consultant"). RECITALS WHEREAS, on or about July 1, 2013, City/Authority entered into a Professional Services Agreement ("Agreement") with Becky Caha to provide housing compliance and monitoring services to the City/Authority; and WHEREAS, on or about July 9, 2014 City/Authority entered into Amendment No. 1 to Professional Services Agreement ("Amendment No. 1") which extended the term of the Agreement to June 30, 2019; and WHEREAS, City/Authority and Consultant wish to amend Exhibit A - Scope of Services of the Agreement to add certain services; NOW THEREFORE, in consideration of the mutual covenant herein contained, the parties agree as follows: AMENDMENT In consideration of the foregoing Recitals and the covenants and promises hereinafter contained, and for good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, the parties hereto agree as follows: 1. EXHIBIT A - SCOPE OF SERVICES is amended to include the following services: Tenant screening both initial and annual, including credit checks, personal references, employment verifications, and other such means of verifying the qualifications of new and existing tenants applying for or living in various City/Authority rental properties. In all other respects, the Agreement and Amendment No. 1 shall remain in full force and effect. IN WITNESS WHEREOF, the City/Authority and Consultant have executed this Amendment No. 2 on the respective dates set forth below. BECKY CAHA, CITY OF LA QUINTA, a sole proprietor & independent contractor a California municipal corporation ATTEST: date , City Manager LA QUINTA HOUSING AUTHORITY, a public body, corporate and politic ►��.�,1'/�+%si Oil �`' J. Spe •a' , Executive Director Susan Maysels, City Clerk APPROVED AS TO FORM: uthority Secretary 6.„ William H. Ihrke, City Attorney & Authority Counsel CALIFORNIA FORM 700 FAIR P01.1 IcAL 'ICES .OMMISSION A PUBLIC DOCUMENT Please type or print in ink. STATEMENT OF ECONOMIC INTERESTS COVER PAGE NAME OF FILER CAHA (LAST) (FIRST) BECKY (MIDDLE) 1. Office, Agency, or Court Agency Name (Do not use acronyms) LA QUINTA HOUSING AUTHORITY 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 feast 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—J December 31, 2015. (Check one) -or- The period covered is through December 31, 2015. ❑ Assuming Office: Date assumed—J ❑ Candidate: Election year — _ Q The period covered is January 1, 2015, through the date of leaving office. -or- Q The period covered is through the date of leaving office. _ _ __ and office sought, if different than Part 1 4. Schedule Summary (must complete) ► Total number of pages including this cover page. 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 ❑ Schedule C - Income, Loans, & Business Positions – schedule attached ❑ Schedule D - Income – Gifts – schedule attached ❑ Schedule E - Income – Gilts – Travel Payments – schedule attached 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - Public Document) 9812 CONTINENTAL DRIVE DIY STATE ZIP CODt HUNTINGTON BEACH CA 92646 DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS ( 760 ) 900-9668 CAHABECKY@GMAIL.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 I (month, day, year) Signature -) 11 ` l�1 fr1478, originally signed statement wall your (ling official) FPPC Form 700 (2015/2016) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov i A�R1` CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10/2612015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA Hiscox 520 Madison Avenue 32nd Floor New York, NY 10022 INSURED 1 REBECCA CAHA 9812 Continental HUNTINGTON BEACH CA 92646 CONTACT NAME: PH Nd Exu. (888) 202-3007 FAX -MAIL n' contact@hiscox.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hiscox Insurance Company Inc 10200 INSURER B : INSURER C : 1 - INSURER D : INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS iNSR 1. TR TYPE OF INSURANCE ADOL INSD SU BR wVe POLICY NUMBER POUCYEFF dII1MIDWYYYY) POLICY EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 CLAIMS -MADE 1X1 OCCUR PREMISES (Ea oocumrnce) $ 100,000 MED EXP (Any one person) $ 5,000 A Y UDC -1314750 -CGL -15 12/10/2015 12/10/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I PRO- JECT LOC PRODUCTS - COMP/OPAGG $ S/T Gen. Agg. OTHER: $ AUTOMOBILE LIABILITY COMSINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ _ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS -- NON -OWNED AUTOS PROPER' AMAGE (Per acsldert $ $ UMBRELLA LIAB_ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED TRETENT ON ,$ _ _ $ - -- WORKERS COMPENSATION PER 0TH - _ STATUTE ER AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N EL. EACH ACCIDENT --- $ I OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CANCELLATION ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 64 604-9•• ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD H I SCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) 104 South Michigan Avenue, Suite 600 Chicago Illinois 60603 Commercial General Liability Declarations In return for the payment of the premium, and subject to all the terms of this Policy, we agree with you to provide the insurance as stated in this Policy. Policy No.: Renewal of: Named Insured Address: Policy period: UDC -1314750 -CGL -15 UDC -1314750 -CGL -14 REBECCA CAHA 9812 Continental HUNTINGTON BEACH, CA 92646 From: December 10, 2015 To: At 12:01 A.M. (Standard Time) at the address shown above. Form of Business: Each Occurrence Limit: Damage to Premises Rented to You Limit: Medical Expense Limit: Personal & Advertising Injury Limit: General Aggregate Limit: Products/Completed Operations Aggregate Limit: All Premises You Own, Rent or Occupy Premises Number: Address: Total Premium: Attachments: December 10, 2016 Individual/Sole Proprietor $ 1,000,000 $ 100,000 Any one premises $ 5,000 Any one person $ 1,000,000 Any one person or organization $ 2,000,000 Products -completed operations are subject to the General Aggregate Limit 9812 Continental HUNTINGTON BEACH, CA 92646 $ 435.00 See attached Forms and Endorsements Schedule. IN WITNESS WHEREOF, the Insurer indicated above has caused this Policy to be signed by its President and Secretary, but this Policy shall not be effective unless also signed by the Insurer's duly authorized representative President Secretary o4-1 ic<2 Authorized Representative CGL D001 01 10 Includes copyrighted material of Insurance Services Office, Inc., with Page 1 its permission. © ISO Properties, Inc., 2000 H I SCOX Policy Number: Named Insured: Endorsement Number: Endorsement Effective: UDC -1314750 -CGL -15 REBECCA CAHA 17 December 10, 2015 Hiscox Insurance Company Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) The City of La Quinta California Munucipal Corporation 78-495 Calle Tampico Po Box 1504 La Quinta,CA 92247 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ACCML7 CERTIFICATE OF LIABILITY INSURANCE kr.,�f _ DATE(MM/DD/YYYY) 10/26/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue 32nd Floor New York, NY 10022 CONTACT NAME: POLICY EFF (MM/DD)YYYY) NAIC # AmGNNo• mil; (888) 202-3007 I ITC Not: E-MAIL contact hlscox.COm ADDRESS: INSURER(S) AFFORDING COVERAGE INSURERA: Hiscox Insurance Company Inc 10200 INSURED REBECCA CAHA 9812 Continental HUNTINGTON BEACH CA 92646 INSURER B : INSURER C • INSURER D : $ INSURER E ; INSURERF: ERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRINSVD TYPE OF INSURANCE AWL WL SUBR POLICY NUMBER POLICY EFF (MM/DD)YYYY) POLICY EXP (MMIODIYYYYt. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ l CLAIMS -MADE I J OCCUR DAMAGE TO RENTED PREMISES (Ea0CCy+rr@r1C) $ MED EXP Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO• JECT LOC PRODUCTS - COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acc[dent) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOSAUTOS -- SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED NUTOS PROPERTYDAMAGE $ _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ _ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICEREtEMBEREXCLUDED? (Mandatory in NH) - N / A E.L. DISEASE - EA EMPLOYEE $ er It yes. CRIPTIO N OF O DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability UDC -1314750 -EO -15 12/10/2015 12/10/2016 Each Claim: $ 1,000,000 Aggregate: $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 61114-9N ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) 104 South Michigan Avenue, Suite 600 Chicago Illinois 60603 Professional Liability Insurance Declarations This is a "Claims Made and Reported" Policy in which Claim Expenses are included within the Limit of Liability unless otherwise noted. Those words (other than the words in the captions) which are printed in Boldface are defined in the Policy. Policy No.: Renewal of: 1. Named Insured: 2. Address: 3.A. Limit of Liability: 3.B. 4. Deductible:. 5. Notice: 6. Policy period: 7. Retroactive Date: 8, Premium: 9 Attachments: UDC -1314750 -EO -15 UDC -1314750 -EO -14 REBECCA CAHA 9812 Continental HUNTINGTON BEACH, CA 92646 $ 1,000,000 Each Claim $ 1,000,000 Aggregate for all Claims $ 1,000 Each Claim Phone: 866-424-8508 Email: reportaclaim@hiscox.com Mail: Hiscox 520 Madison Avenue -32nd Floor Attn: Direct Claims New York, NY, 10022 From: December 10, 2015 V To: December 10, 2016 At 12:01 A.M. (Standard Time) at the address shown above. June 01, 2012 $ 400.00 DPL D001 CW (01/10) - Professional Liability Errors & Omissions Insurance Declarations DPL P001 CW (05/13) - Professional Liability Coverage Form DPL E5000 CW (01/10) - E5000.1 Additional Insured DPL E5018 CW (01/10) - E5018.1 Management/Business Consulting Services Endorsement DPL E5102 CA (01/10) - E5102.1 California Amendatory Endorsement DPL E5424 CW (02/15) - Blanket Additional Insured Endorsement INT N001 CW (01/09) - Economic And Trade Sanctions Policyholder Notice DPL D001 CW (01/10) Page 1 CALIFORNIA FORM 700 FAIF<' POL ,ICAL 'RAC?ICES _OMMISSION A PUBLIC DOCUMENT Please type or print in ink. STATEMENT OF ECONOMIC INTERESTS COVER PAGE Date Initial Filing Received NAME OF FILER (LAST) CAHA (FIRST) BECKY (MIDDLE) 1. Office, Agency, or Court Agency Name (Do not use acronyms) LA QUINTA HOUSING AUTHORITY 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 or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County ❑ County of City of _LA QUINTA ❑ Other 3. Type of Statement (Check at least one box) Annual: The period covered is January 1, 2015, through December 31, 2015. The period covered is _J—J , through December 31, 2015. ❑ Assuming Office: Date assumed -or- Ell Leaving Office: Date Left—J (Check one) p The period covered is January 1, 2015, through the date of leaving office. -or- 0 The period covered is , 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: 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 - Gilts - schedule attached 0 Schedule E - Income - Gifts - Travel Payments - schedule attached MAILING ADDRESS STREET (Business Of Agency Address Recommended - Public Document) 9812 CONTINENTAL DRIVE cm STATE ZIP CODE HUNTINGTON BEACH CA 92646 DAYTIME TELEPHONE NUMBER ( 760 ) 900-9668 E-MAIL ADDRESS CAHABECKY@GMAIL.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 Signature (month, day. year) (F ''1 he 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 CALIFORNIA FORM 700 FAIR PO1111CAL PRACTICES COf,1'.ISSIi! . A PUBLIC DOCUMENT Please type or print in ink. NAME OF FILER (0Si Caha STATEMENT OF ECONOMIC INTERESTS COVER PAGE RECEIVED Date Initial Filing Received JUl '' 2-'9 O17 (FIRST) Becky CITY OF LA QUINTA CITY CLERK. DEPARTMENT (MIDDLE) 1. Office, Agency, or Court Agency Name (Do not use acronyms) La Quinta Housing Authority 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 0 Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County ❑ County of ❑ Other ❑ City of La Quinta 3. Type of Statement (Check at least one box) O Annual: The period covered is January 1,A01: through ❑ Leaving Office: Date Left i -off December 31, 204 20It, (Check one) The period covered is '_____/ through December 31, 2015. ❑ Assuming Office: Date assumed _II/ ❑ Candidate: Election year p The period covered is January 1, 2015, through the date of leaving office. -or- Q The period covered is _J—J , through the date of leaving office. and office sought, if different than Part 1 4. Schedule Summary (must complete) ► Total number of pages including this cover page: 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 ❑ 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 - Pubic Document) 9812 Continental Drive CITY Huntington Beach STATE ZIP CODE CA 92646 L4YTIME TELEPHONE NU ER E-MAIL ADDRESS ( 760 ) 900-9668 cahabecky(gmail.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 2-2z\2.D1lO Signature (month, dax yea osiginely signed stormed wlhyour king offriaL) FPPC Form 700 (2015/2016) FPPC Advice Email: advice)fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COt.lrIISSION A PUBLIC DOCUMENT Please type or print in ink STATEMENT OF ECONOMIC INTERESTS COVER PAGE RECEIVED Initial Filing Received "'Mil"! 7 2017 CITY OF LA QUINTA CITY CLERK DEPARTMENT NAME OF FILER (LAST) Caha (FIRST) Becky (MIDDLE) 1. Office, Agency, or Court Agency Name (Do not use acronyms) La Quinta Housing Authority Division, Board, Department, District, if applicable Your Position Consultant ► If filing for multiple positions, fist below or on an attachment. (Do not use acronyms) Agency. Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County _ _ ❑ County of City of La Quinta ❑ Other 3. Type of Statement (Check at least one box) gi Annual: The period covered is January 1, through ❑ Leaving Office: Date Left I ) December 31, 2P15:- 2DIke (Check one) -or- '2011e The period covered is —J through December 31, 2015. ❑ Assuming Office: Date assumed _J—J o The period covered is January 1, 2015, through the date of leaving office. -or- p The period covered is 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: Schedules attached ❑ Schedule A-1 - Investments- schedule attached ❑ Schedule A-2 - Investments - schedule attached ❑ Schedule B - Real Properly - schedule attached -or- ti None - No reportable interests on any schedule ❑ Schedule C - Income, Loans, & Business Positions - schedule attached 0 Schedule D - Income - Gifts - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Document) 9812 Continental Drive Huntington Beach CA 92646 DAYTIME TELEPIDNE NUMBER I E-MAIL ADDRESS ( 760 ) 900-9668 cahabecky@gmail.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. //\7Z\ Date Signed (month, dak yew) • Signature 6.[. he angineey 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