700 NV5 (Fahrion) 2021RECEIVED
STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
CALIFORNIA FORm7OO
F-!wo oac,ir Usc Only
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE FEB 15 2022 ve
A PUBLIC DOCUMENT
CITY. OF LA QUINTA
Please type or print in ink. IrtTY N•
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 least one box)
❑ State ❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
❑ Multi -County
❑■ City of La Quinta
(Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
■ Annual: The period covered is January 1, 2021, through ❑ Leaving Office: Date Left I
-or-
December 31, 2021. (Check one circle.)
The period covered is I through C The period covered is January 1, 2021, through the date of
December 31, 2021. -or-leaving office.
F_ Assuming Office: Date assumed 1 C The period covered is I through
the date of leaving office.
Candidate: Date of Election _ and office sought, if different than Part 1.
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
n Schedule D - Income — Gifts — schedule attached
Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
CA
DAYTIME TELEPHONE NUMBER 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
FPPC Form 700 -Cover Page (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 5