Lobbying Registration
Maryland State Ethics Commission | 45 Calvert Street, 3rd Floor, Annapolis, Maryland 21401
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Form ID: R011061
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Submission Date: 12/03/21
Registrant Information
| Individual Registrant | |
|---|---|
| Name of Registrant: Travis Blake Simon | Business Phone: 301-740-7100 |
| Organization: SEIU Local 500 | Cell Phone: 540-335-2969 |
| Address: 901 Russell Ave, Foor 2, Gaithersburg, MD, 20895 | |
1. Are there any other individuals who are required to register on behalf of the registrant:
Travis B Simon?
Note: These individuals will still be required to submit their own registrations.
Note: These individuals will still be required to submit their own registrations.
No
2. Are you in compliance with the mandatory training requirements of the Public Ethics Law?
Yes, I certify that I am current in my training status.
Date of most recent training:
05/17/21
Employer Information
1. Identify the employer that compensates the registrant for lobbying activities under this registration.
| Employer of Registrant | |
|---|---|
| Organization: SEIU Local 500 | Website: www.seiu500.org |
| Nature of Business: Labor Union | Phone: 301-740-7100 |
| Address: 12 Taft Court, Floor 2, Rockville, MD, 20850 | |
2. Does your employer claim an exemption from filing its own registration and activity reports?
Yes
3. Is the employer organized for the primary purpose of attempting to influence any legislation or executive action?
No
4. In the course of representing this employer, will you also be representing other entities from which you will not be receiving compensation and are not required to register on their behalf?
No
Lobbying Period & Purpose
1. Within a lobbying year, state the period for which this registration is effective. Include both a start and an end date.
Registration Period:
Custom Dates: 11/30/2021 - 10/31/2022
2. What type of lobbying registration are you seeking?
Legislative Action, Executive Action, Grassroots
3. Identify the subject matters on which the registrant expects to act, or employ someone to act during the registration period. You must identify at least one subject matter and you may select up to five.
| # | Subject Matter | Description |
|---|---|---|
| 1 | Education - Local Bills | |
| 2 | Children | |
| 3 | Workers' Compensation | |
| 4 | Higher Education |
Authorization to Lobby
The registrant is authorized to act on behalf of the employer identified above, for the period specified and as to the matters selected herein unless this authority is terminated sooner. This authorization has been granted by the representative disclosed below:
Name of Authorizer: Pia Morrison
Title: President
Email: morrisonp@seiu500.org
Phone: 301-740-7100
Address: 901 Russell Avenue, Suite 300, Gaithersburg, MD, 20879
Affirmation Provision
I hereby make oath or affirm under the penalties of perjury that I am authorized to engage in lobbying activity on behalf of the employer: SEIU Local 500, for the period specified and as to the matters selected herein, unless this authority is terminated sooner. This authorization has been granted to me by the representative: Pia Morrison. I acknowledge that my electronic signature subjects me to the penalties of perjury to the same extent as an oath or affirmation made before an individual authorized to administer oaths, and swear that the contents of this registration are complete and accurate to the best of my knowledge and belief.
E-signature: Travis B Simon