HomeMy WebLinkAbout2023-12-18 Form 806FPPC Form 806 (1/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Comment:
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
2. Appointments
3. Verification
I have read and understand FPPC Regulation 18702.5. I have verified that the appointment and information identified above is true to the best of my information and belief.
Signature of Agency Head or Designee Print Name Title (Month, Day, Year)
Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1.Agency Name
Designated Agency Contact (Name,Title)
E-mail
Division, Department, or Region (If Applicable)
806
For Official Use Only
Area Code/Phone Number
(Month, Day, Year)
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____
Date Posted:
CITY OF PALM DESERT
CITY CLERK
ANTHONY MEJIA
(760) 346-0611 amejia@cityofpalmdesert.org
1 4 12/19/2023
California Joint Powers
Insurance Authority
Trubee, Evan
Risk Manager
12 14 23
1 year
100
n
CVAG (Coachella Valley
Association of
Governments) - Coachella
Valley Conservation
Commission
Trubee, Evan
Kelly, Kathleen/Cncl.
12 14 23
1 year
75
n
CVAG - Energy &
Environmental Resources
Committee
Nestande, Gina
Trubee, Evan/Cncl.
12 14 23
1 Year
75
n
CVAG - Executive
Committee
Kelly, Kathleen
Harnik, Jan
12 14 23
1 year
100
n
ANTHONY MEJIA CITY CLERK 12/18/2023
CITY COUNCIL LIAISON APPOINTMENTS APPROVED/CONFIRMED AT MEETING OF 12/14/2023
Print Clear
DocuSign Envelope ID: 9D4E949E-273F-4C8D-B3A6-D1D48768580D
FPPC Form 806 (1/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Background
This form is used to report additional compensation that officials
receive when appointing themselves to positions on committees,
boards, or commissions of another public agency or to a
committee or position of the agency of which the public official is
a member.
This form is required pursuant to FPPC Regulation 18702.5.
Each agency must post on its website a single Form 806 which
lists all the paid appointed positions to which an official will vote
to appoint themselves. When there is a change in compensation
or a new appointment, the Form 806 is updated to reflect the
change. The form must be updated promptly as changes occur.
Instructions
This form must be posted prior to a vote (or consent item) to
appoint a governing board member if the appointee will participate
in the decision and the appointment results in additional
compensation to the appointee.
FPPC Regulation 18702.5 provides that as long as the public
is informed prior to a vote, an official may vote to hold another
position even when the vote results in additional compensation.
Part 1. Agency Identification
Identify the agency name and information on who should be
contacted for information.
Part 2. Appointments
Identify the name of the other agency, board or commission. List
the name of the official, and an alternate, if any.
List the appointment date and the length of term the agency
official will serve. Disclose the stipend provided per meeting and
the estimated annual payment. The annual salary is an estimate
as it will likely vary depending upon the number of meetings. It
is not necessary to revise the estimate at the end of the calendar
year.
Part 3. Verification
The agency head or his/her designee must sign the verification.
Frequently Asked Questions (FAQs)
1.When does an agency need to complete the Form 806?
A Form 806 is required when an agency’s board members
vote to appoint a board member to serve on another
governmental agency or position of the agency of which the
official is a member and will receive additional compensation.
2.The city council votes to serve as the city’s housing authority,
a separate entity. Will the Form 806 be required?
If the council members receive additional compensation for
serving on the housing authority, the Form 806 is required.
3.Are appointments made by a governing board to appoint
one of its members to serve as an officer of that board for
additional pay (e.g., mayor) required to be disclosed on Form
806?
No. FPPC Regulation 18702.5(b)(6) exempts from this
requirement decisions to fill a position on the body of which
the official is a member (such as a councilmember being
appointed as mayor) despite an increase in compensation.
4.In determining the income, must the agency include mileage
reimbursements, travel payments, health benefits, and other
compensation?
No. FPPC Regulation 18702.5 requires only the amount of
the stipend or salary to be reported.
5.Which agency must post the Form 806?
The agency that is voting to appoint a public official must post
the Form 806 on its website. The agency that the official will
serve as a member is not required to post the Form 806. The
form is not sent to the FPPC.
6.When must the Form 806 be updated?
The Form 806 should be amended promptly upon any of
the following circumstances: (1) the number of scheduled
meetings is changed, (2) there is a change in the
compensation paid to the members, (3) there is a change in
membership on the board or commission, or (4) there is a
new appointment to a new agency.
7.If officials choose to recuse themselves from the decision
and leave the room when a vote is taken to make an
appointment, must the Form 806 be completed?
No. The Form 806 is only required to identify those officials
that will vote on an appointment in which the official will also
receive additional compensation.
Privacy Information Notice
Information requested by the FPPC is used to administer and
enforce the Political Reform Act. Failure to provide information
may be a violation subject to penalties. All reports are public
records available for inspection and reproduction. Direct
questions to FPPC’s General Counsel, Fair Political Practices
Commission, 1102 Q Street, Suite 3000, Sacramento, CA 95811.
California
Form 806
A Public Document
Agency Report of:
Public Official Appointments
DocuSign Envelope ID: 9D4E949E-273F-4C8D-B3A6-D1D48768580D
FPPC Form 806 (1/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
Continuation Sheet
2. Appointments
Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1.Agency Name
806
(Month, Day, Year)Date Posted:
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
Name
Name
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
Other
Other
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____
CVAG (Coachella
Valley Association
of Governments) -
Homelessness
Committee
Greater Palm Springs
CVA/CVB
CVAG - Public
Safety Committee
CVAG - Transportation
Committee
CVAG - Personnel
Committee
Jacqueline Cochran
Regional Airport Authority
2 4
CITY OF PALM DESERT
12/19/2023
Kelly, Kathleen
Quintanilla, Karina/Cncl
12 14 23
1 year
50
n
Kelly, Kathleen
Harnik, Jan/Cnlc
12 14 23
1 Year
75.00
n
Quintanilla, Karina
Trubee, Evan/Cncl
12 14 23
1 Year
75.00
n
Harnik, Jan
Kelly, Kathleen/Cncl.
12 14 23
1 Year
75.00
n
Harnik, Jan
Quintanilla, Karina
12 14 23
1 Year
100.00
n
Harnik, Jan
Trubee, Evan/Cncl.
12 14 23
1 Year
50.00
n
Print Clear
DocuSign Envelope ID: 9D4E949E-273F-4C8D-B3A6-D1D48768580D
FPPC Form 806 (1/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
Continuation Sheet
2. Appointments
Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1.Agency Name
806
(Month, Day, Year)Date Posted:
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
Name
Name
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
Other
Other
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____
Riverside County
Transportation
Commission
Palm Desert Housing
Authority
Palm Desert
Housing Authority
Palm Desert Housing
Authority
SunLine Transit
Agency Board
Palm Desert Housing
Authority
3 4
CITY OF PALM DESERT
12/19/23
Harnik, Jan
Kelly, Kathleen, Cnclmbrs.
12 14 23
1 year
100
n
Kelly, Kathleen
Harnik, Jan, Cnclmbrs.
12 14 23
1 year
50
n
Quintanilla, Karina 12 10 20
4 years
50
n
Harnik, Jan 12 15 22
4 years
50
n
Kelly, Kathleen 12 10 20
4 years
50
n
Nestande, Gina 12 10 20
4 years
50
n
Print Clear
DocuSign Envelope ID: 9D4E949E-273F-4C8D-B3A6-D1D48768580D
FPPC Form 806 (1/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
Continuation Sheet
2. Appointments
Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1.Agency Name
806
(Month, Day, Year)Date Posted:
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
Name
Name
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
Other
Other
____/____/____
Appt Date
____/____/____
Appt Date
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____
Palm Desert
Housing Authority
4 4
CITY OF PALM DESERT
12/19/23
Trubee, Evan 12 15 22
4 years
50
n
Print Clear
DocuSign Envelope ID: 9D4E949E-273F-4C8D-B3A6-D1D48768580D