Teddy Seijo/Comm. AIDS
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON FORM
lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Seijo, Teddy
NAME OF lOBBYIST:
(Last)
(First)
(M .1)
~'m.it~ ~ID5 ~9'Slo"rctii' T'ni"".. ~h~ C:7"Y"o ROCf"'\11"Y"f"""O. <l;lf'l 'Rict""";llTnO Rl~Tn M;;:nni, FL
BUSINESS NAME A 0 ADDRESS (Number and Street) (City) (State) (Zip Code) 33137
(305) 576-1234 (305) 571-2020 tseijo@careresource.org
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Corrmuni ty AIDS Resource, Inc., dba Care Resource
NAME OF PRINCIPAl.jCUENT:
3510 Biscayne Boulevard, Suite 300, Miami, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
(JQ~) ~'76-1234
TElEPRO'Nt: NUMBER:
(305) 571-2020
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Miami Beach Visitor & Convention Authority Tourism Advancement Grant Application
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
1iami Beach Visitor & Convention N/A
Authoritv Board
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) No compensation other than regular salary.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). No compensation.
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
D Yes III No: Are YOU lobbyina on a oresent or oendina bid for aoods. eauioment or services. or on a
oresent or oendina award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes Ol No: Are YOU 10bbYina on a oendina aoolication for a Develooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
"'. Yes 0 No: Are YOU reoresentina a not-for-orofit corooration or entity without sDecial comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
~'
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
VI.
Form of Identification
Signature of Lobbyist:
Signature of Principal/Client:
..--
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
~ersonally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This :::2 g- day of -1\ J 5i.JS t . 2005-
Cc~ @n
Signature f Public Notary - State of FlOrida
<. ~::) Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This~day ofl\jjiJ~ . 20 ~ S-
~f~
Signature of Pu lic Notary - State of Florida
Notarization of Principal's signature
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~~1 .~ t.: Annual Registration fee: [ ] Yes [V] No A~t Pajd MCR #
'>1 ~j Lobbyist Registration Form received and verified by' ~l.t 11 ..../3{)t21MJ'.JJ.,f
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 5. DC
Date Paid
Revised 12/08/04