Form 700 NV5 (Fahrion) 2018Please type or print In Ink.
NAME OF FILER (LAST)
Fahrion
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
NV5, Inc.
Division, Board, Department, District, if applicable
STATEMENT OF ECONOMIC INTERESTS
(FIRST)
Jay
COVER PAGE
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
❑ Multi -County
IN City of La Quinta
3. Type of Statement (check at least one box)
Date Initial Filing Received
;,,, r;� omy
(MIDDLE)
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
® Annual: The period covered is January 1, 2017, through ❑ Leaving Office: Date Left
-or- December 31, 2017. (Check one)
The period covered is i through O The period covered is January 1, 2017, through the date of
December 31, 2017. -or- leaving office.
❑ Assuming Office: Date assumed ) / O The period covered is i through
the date of leaving office.
❑ Candidate: Date'of Election 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 C - Income, Loans, 8 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 CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Documenl)
42-829 Cook Street, Suite 104 Palm Desert CA 92211
DAYTIME TELEPHONE NLIMBeR E-MAIL ADDRESS
( 760 ) 341-3101 1 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 tJthheegoing Is true and correct.
8/23118 Date Signed Signa_ _
(month, day, year) IF'the on kdy signed arelement with your tiling ollidal.)
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpllne: 866/275-3772 www.fppc.ca.gov