HomeMy WebLinkAbout2024-03-21 Form 804 (2)Agency Report of:
:i Calif i ornia New Positions A Public Document V M Form 80A
1. Agency Name (Also include, Division, Department, or Region (if applicable))
City of Palm Desert
Agency Contact
Anthony Mejia, City Clerk
Phone Number
760-776-6402
2. New Position Information
MA r OWnt P.M 3: 1.3
Date of Original Filing:
(month, day, year)
:Mail
amejia@palmdesert.gov
3.. Verification
have read and understand FPPC Regulations 18700.3 and 18734. I have verified that the disclosure assignment(s) set forth above, is
in accordance with its provisions.
Anthony Mejia City Clerk 03 I? -1,/ zol:q
Sig ature Name Tide (month, day, year)
Comment: (us -TtFis space or an attachment for any additional information.)
FPPC Form 804 (2116)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Agency Report of:
New Positions
A Public Document
State and local government agencies may use this form
to identify new positions that will make or participate in
making governmental decisions on behalf of the agency.
An individual in a newly created position must file a
Statement of Economic Interests (Form 700) within 30
days of assuming office.
This form identifies the Statement of Economic Interests,
Form 700, disclosure requirements for individuals serving
in new positions. This form is for the agency's internal
use and should be maintained by the agency in the same
manner as the agency's conflict of interest code. For more
information, refer to the FPPC website www.fppc.ca.gov
and Regulations 18700.3 and 18734.
Disclosure Requirements
• Disclosure requirements should conform to the range of
duties.
• Alternatively, the agency must require an individual
to file under the broadest disclosure category in the
agency's conflict of interest code or, if the agency does
not have a conflict of interest code, full disclosure.
Full disclosure includes reporting all investments, business
positions, and interests in real property held on the date
of assuming office and income received during the 12
months immediately preceding assuming office.
When a new position is added, in addition to completing
this form, the agency should begin the process to amend
the conflict of interest code.
Examples:
An agency added a new data processing manager
position. The individual will be assigned the same
disclosure category that the agency's other IT staff are
assigned.
An agency implemented a new licensing program and a
new manager position was added. Because this was a
new program, the agency provided a written description
of the individual's disclosure requirements which included
sources subject to the licensing procedures.
An agency reorganized and changed the duties of several
positions listed in the conflict of interest code. This form is
not required as positions are not new. The agency should
begin to amend its conflict of interest code if the range of
authority and types of decisions changed.
An agency changed the titles bu� not the duties and
responsibilities of several positio s. This form is not
required. The agency must file an amendment to update
the conflict of interest code.
Instructions
Part 1
Identify the agency, contact information, and provide the
amendment explanation in the comment section when
applicable.
Part 2
Identify the new position(s) and escribe the position's
duties. Identify the disclosure bpi:
— Assigning an existing cate ory(s) in the agency's
code, or
— Writing a disclosure requirement.
Complete if the agency knows the employment date.
Part 3
The agency's conflict of interest code should identify the
position that is responsible for th� verification.
Example
Agency Report of:
New Positions
A Public Docu
ent
1. Ageney Name ia..umw.. w.ma. o.e.,,....„a.s�..mwa�u.n
pa —h,
CA Joint Powers Authority
..
A9.nry eontaa
or orwn, rmre:
n�nm ®n
SmAh, Adam Executive Director
Ph... Number
Email
555-555-5555
adam.
mith@cjpa.ca.gov
2. New Position Information
P t 71t lclat n "A5510 do t a. rY OR a.
i s R QuG vm mis a
ndJob Summary
t R
Data Processing Manager
(manages IT Dept)
3
m a ra
rd
Licensing Director
All in
testments, business
(duty statement attached)
3
posit
ons in business entities,
and iounces
wr
Licensing Director
of in
ome, including gifts, loans,
(duty statement attached)
3
and tFavel
entt
payments, from
s
—r L
1 e n
Licensing Director
that
Ire of the type subject to
(duty statement attached)
3
licensing
by the Department or
L
are s
bject
_r
m d 1,
to regulation
by the
Licensing Director
(duty statement attached)
3
Department.
r r
m !a t>.
Licensing Director
(Alternately,
attach a
(duty statement attached)
3
wri4nexplanation.)
d. VedOcetlon
94� S- 4 Adam Smith I Executive Director ' 3.10-xx
s em w.. i nve �naa.m,n
Comment: (
FPPC