Form 700 NV5 (Fahrion) 2019STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER (LAST) (FIRST)
Fahrion Jay
1. Office, Agency, or Court
Agency Name (Do not use acro yms)
� N c. N � V, 9d-0�
ivision, Board, Department, Distkbt, if applicable
S
Your Position
Consultant
► 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:
Date Initial Filin _I Received
CITY OF LA QuINTA
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (check at least one box)
xj Annual: The period covered is January 1, 2018, through ❑ Leaving Office: Date Left
December 31, 2018. (Check one circle.)
.or -
The period covered is
December 31, 2018.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
through O The period covered is January 1, 2018, through the date of
-or- leaving office.
O 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 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- 4 None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
42-829 Cook Street, Suite 104 Palm Desert CA 92211
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 760 ) 341-3101 1jay.fahrjon9nv5.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 7/17/2019 Signature �,4;? -
(month, day, year) (File the originally signed paper statement with your filing official.)
FPPC Farm 700 (2019/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 066/275-3772 www.fppc.ca.gov
Page - 5
STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
OMCIEP Use On,
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Fahrion Jay S.
1. Office, Agency, or Court
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 feast one box)
❑ State
❑ Multi -County
❑x City of La Quinta
3. Type of Statement (Check at least one box)
x❑ Annual: The period covered is January 1, 2018, through
December 31, 2018.
.or -
The period covered is I through
December 31, 2018.
❑ Assuming Office: Date assumed I I
❑ Candidate: Date of Election
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left
(Check one circle.)
O The period covered is January 1, 2018, through the date of
-or- leaving office.
Q The period covered is 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:
Schedules attached
❑ Schedule A-1 - Investments - schedule attached
❑ Schedule A-2 - Investments - schedule attached
❑ Schedule B - Real Property - schedule attached
-or- X 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
( 760 ) 341-3101
❑ 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
Palm Desert CA 92211
EMAIL ADDRESS
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 that the j6rggoing is true and correct.
fi �� r. 10
Date Signed �!/`3�20
(month, day, year)
(File the originally signed paper statement with your tiling official)
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275.3772 www.fppc.ca.gov
Page - 5