Form 700 Bengal Engineering (Wahiduzzaman) 2017STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink.
Date Initial Filing Received
Official Use Only
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Wahiduzzaman Mohammed
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
Dept. of Public Works
Your Position
Consultant, Civil Engineering Design
► 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
0 City of LA Quinta, CA
3. Type of Statement (check at least one box)
❑x Annual: The period covered is January 1, 2017, through
December 31, 2017.
.or -
The period covered is I I
December 31, 2017.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
Position
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left
(Check one)
through O The period covered is January 1, 2017, through the date of
-or-
leaving office.
O The period covered is I i.. _ 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: 1
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 CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
250 Big Sur Drive Goleta CA 93117
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 805 ) 563-0788, ext. 101 Md@Bengalengineering.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) (File the originally signed statement with your filing official)
FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov