Form 700 NAI Consulting 2018 (Nickerson, Lloyd)STATEMENT OF ECONOMIC INTERESTS Dal-, Initial Filing Re�-eived
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COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Nickerson, Jr. Lloyd
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
Your Position
Contract Project Manager
► 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
x] City of La Quinta
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other —
3. Type of Statement (check at feast one box)
x❑ Annual: The period covered is January 1, 2018, through ❑ Leaving Office: Date Left I - I
-or-
December 31, 2018. (Check one circle.)
The period covered is I through O The period covered is January 1, 2018, through the date of
December 31, 2018, -or- leaving office.
❑ Assuming Office: Date assumed O The period covered is I 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: 3
Schedules attached
❑ Schedule A-1 - Investments - schedule attached
x❑ Schedule A-2 - Investments - schedule attached
❑ Schedule B - Real Property - schedule attached
-OP- ❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
68-955 Adelina Road
DAYTIME TELEPHONE Nl1MRFR
❑x Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
CITY STATE ZIP CODE
Cathedral City CA 92234
( 760 ) 323-5344 _ 1 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 corr t.
j�
Date Signed .r a 0� Signature
(month, day, year) (File+ MglnaRySiQ9CNpeper sfalement with your filing official.)
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
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SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
NAI Consulting, Inc.
Name
68-955 Adelina Road, Cathedral City, CA 92234
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 x❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
Civil Engineering Firm
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$0 - $1,999
$2,000 - $10,000 18
$10,001 - $100,000 ACQUIRED DISPOSED
D $100,001 - $1,000,0o0
❑X Over $1.000,000
NATURE OF INVESTMENT $-Corp
❑ Partnership ❑ Sole Proprietorship X❑
YOUR BUSINESS POSITION President
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 X❑ OVER $100,000
❑ $1,001 - $10,000
F-1 None or _q Names listed below
My-ofLa-Qui 1.t3.
Check one b-ox
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real
Property
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,00o
18
❑ $100,001 - $1,000.000
ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust
❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
TITremaining
❑ Check box if additional schedules reporting investments or real property
are attached
Name
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
LloydName
Nickerson, Jr.
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ 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 - $10.000 118
❑ $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
❑ $0 - $499 ❑ $1o,00l - $10o,000
❑ $Soo - $1,000 ❑ OVER $100.000
❑ $1,001 - $10,000
None or I I Names listed below
Check one box
[:]INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, Qt
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10.000
$10,001 - $100.000
$100.001 - $1.000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OFINTEREST
❑ 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 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 9
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
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
Civil Engineering Firm
YOUR BUSINESS POSITION
President
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10.000
❑ $10,001 - $100,000 ❑X OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑X 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 or $10,000 or more
(Describe)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
Lloyd Nickerson, Jr,
NAME OF SOURCE OF INCOME
California Department of Tax and Fee Administration
ADDRESS (Business Address Acceptable)
3737 Main Street, Ste. 1000, Riverside, CA 92501
BUSINESS ACTIVITY, IF ANY, OF SOURCE
State Agency
YOUR BUSINESS POSITION
Spouse of District Principal Auditor
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑X OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑X 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 or S10,000 or more
(Describe)
❑ Other I I ❑ Other
(Describe) ` I (Describe)
0- 1 LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from a commercial lending institution, 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 - $100.001)
❑ OVER $100,000
Comments:
INTEREST RATE TERM (Manths/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Sheet address
❑ Guarantor
❑ Other
city
(Describe)
FPPC Form 700(2018/2019)
FPPC Advice Email: advlce@fppc.ce.gov
FPPC Toll -Free Helpline: 866/275.3772 www.fppe.ca.gov
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