I.

INTRODUCTION

On June 2, 2023, Orlando Police Department (OPD) Officer Michael Mastrangelo responded to 1250 West
South Street, OPD Headquarters (OPH), where he met with three (3 ) individuals who completed sworn
written statements documenting criminal allegations made against the owners of the Pulse Nightclub
(Pulse) and stemming from the shooting incident which occurred at Pulse on June 12, 2016. Officer
Mastrangelo also accepted numerous documents from this group which included a study titled, "They
Knew - Hard Evidence that Poma's Legal Violations and City Failures Led to Further Injury and Death at
Pulse Nightclub" ("They Knew"). Officer Mastrangelo completed a Case Report documenting this group's
allegations and placed these documents in OPD's Property and Evidence.

On July 23, 2023, OPD Officer Javier Medina responded to OPH where he met with eighteen (18)
individuals who completed sworn written statements documenting their belief the owners of Pulse
committed criminal violations stemming from the June 12, 2016, shooting at Pulse. Officer Medina
completed a Case Report Supplement documenting his involvement.

On August 14, 2023, OPD Officer Brittany Bombaro responded to OPH where she met with one (1)
individual who completed a sworn written statement and who also made criminal allegations against the
owners of Pulse. Officer Bombaro completed a Case Report Supplement documenting her involvement.

On September 13, 2023, OPD Sergeant Loida Rennish responded to OPH where she met with one (1)
individual who completed a sworn written statement also alleging criminal acts against the owners of
Pulse. Sergeant Rennish completed a Case Report Supplement documenting her involvement.

On October 5, 2023, I, OPD Sergeant Michael Stanley was assigned this incident for additional investigative
follow-up.

II. BACKGROUND

On June 12, 2016, at 0202 hours, Omar Mateen (the Suspect) conducted a mass shooting at Pulse located
at 1912 South Orange Avenue . The Suspect was a lone gunman and was responsible for the killing of
forty-nine (49) people and the wounding of fifty-three (53) other individuals. This shooting was
determined to be the deadliest terrorist attack on American soil since September 11, 2001. 1

Ill. ALLEGATIONS

The allegations made by the complainants within their sworn written statements are summarized into
these five (5) issues as found within "They Knew":

1. The unavailability of building plans to first responders duri ng the three -hour long hostage
situation, as law enforcement dealt with the chaos of navigating a dark building with limited
layout information and an active shooter.
2. Un permitted renovations and building modifications done to the i nte rio rand exterior of the Pulse
Nightclub and left unchecked and unregulated by the City of Orlando.
3. A history of occupancy violations which public records and su r vivor records show the nightclub
was likely over capacity on the night of the shooting .

1
The FBI labeled the Pulse attack an act of t errorism according to 18 U.S.C § 23 31 (2009)
 4. Years of Pulse operating in violation of their conditional use permit, which allowed the business
to operate as a restaurant and martini bar with strict written limitations and not as a
nightclub/dance hall.
5. Other general failures in security and risk management.

The complainants believe the Poma's operated their nightclub illegally a nd made illegal business decisions
which put the lives of their customers at risk.

IV. INVESTIGATIVE THRESHOLD

The investigative threshold for this investigation is probable cause. While there is no statutory definition
of probable cause in the State of Florid a, probable cause is generally understood to be an officer's
knowledge of facts and circumstances based on reasonable trustworthy information sufficient to warrant
a prudent person to be li eve a crime has been committed . The probable cause standard is incapable of
precise definition or quantification into percentages because it deals with probabilities and depends on
the totality of the circumstances. 2

V. CRIMINAL STATUTE BEING INVESTIGATED

From the allegations made by the complainants against Barbara and Rosario Poma, the owners of Pulse
Nightclub, this investigation sought to determine if probable cause exists to charge the Poma's with F.S.
782.07-3, Involuntary Manslaughter by Cu lpab le Negligence. This statute is defined as, "The killing of a
human being by the act, procurement, or cu lpable negligence of another, without lawful justification
according to the provisions of chapter 776 and in cases in which such killing shall not be excusab le
homicide or murder, according to the provisions of this chapter, is manslaughter, a felony of the second
3
degree."

As stated by the Florida Bar under Criminal Jury Instructions, to prove the crime of Manslaughter, the
State must prove the following two elements beyond a reasonable doubt :

1. (Vi ctim ) is dead.

Give 2a, 2b, and/or 2c depending upon allegations and proof.

2. a. (Defendant) intentionally committed an act or acts that caused the death of (vi ctim).

b. (Defendant) intentionally procured an act that caused the death of (victim).

c. The death of (victim) was caused by the culpab le negligence of (d efendant) .

Within their Crimina l Jury Instructions, the Florida Bar defines cu lp able negligence as:

I will now define "culpable negligence" for you. As I have said, every person has a duty to act reasonably
toward others. If there is a violation of that duty, without any conscious intention to harm, that violation
is negligence . But cu lpable negligence is more than a fai lure to use ordinary care toward others. In order
for negligence to be cu lp ab le, it must be gross and flagrant. Culpab le negli gence is a course of conduct
showing reckless disregard of human life, or of the safety of persons exposed to its dangerou s effects, or

2
Maryland v. Pringle, 540 U.S . 02-809 (2003) .
3
2023 Florida State Statues
such an entire want of care as to raise a presumption of a conscious indifference to consequences, or
which shows wantonness or recklessness, or a grossly careless disregard for the safety and welfare of the
public, or such an indifference to the rights of others as is equivalent to an intentional violation of such
rights.

The negligent act or omission must have been committed with an utter disregard for the safety of others.
Culpable negligence is consciously doing an act or following a course of conduct that the defendant must
4
have known, or reasonably should have known, was likely to cause death or great bodily injury.

VI. AVAILABLE EVIDENCE

The evidence provided by the complainants and located within OPD Property and Evidence consists of the
following items:

1. "They Knew" - Hard Evidence that Poma's Legal Violations and City Failures Led to Further
Injury and Death at Pulse Nightclub."
2. Permitting/Code Enforcement/Planning/Fire/Life-Safety Time line
3. Orlando Sentinel article dated July 30, 2016, and titled, "Fence at Pulse wasn't permitted."
4. City of Orlando Municipal Planning Board Agenda Item 12 - Rosario Poma and dated July 15,
2003.
5. An email dated May 26, 2023, and titled, "TDT Grant for onePulse Foundation - DO NOT
APPROVE."
6. An article from 2018 titled, "Fatal Wounding Pattern and Causes of Potentially Preventable
Death Following the Pulse Night Club Shooting Event."
7. An email dated June 12, 2016, at 0933 hours from Orlando Fire Department (OFD) Fire
Marshal Tammy Hughes to OFD Chief Roderick S. Williams.
8. Twenty-three (23) sworn written statements from the complainants.

Additional evidence relied upon for this investigation:

9. Florida Department of Law Enforcement Use of Force Investigation, Case Number OR-27-
0258. 5
10. OPD Homicide Unit Supplement Report, Case Number 2016-242039. 6
11. "Rescue, Response, and Resilience - A critical incident review of the Orlando public safety
response to the attack on the Pulse nightclub" conducted by the U.S. Department of Justice,
Office of Community Oriented Policing Services. 7
12. Pulse Nightclub Shooting - FBI Lab Ballistics Report. 8

4
https ://www.floridabar.org/ru les/florida-standard-ju ry-i nstructions/ crim ina I-ju ry-i nstructions-home/crim inal-
j ury-instructions/sji-criminal-chapter- 7/
5
https://media.clickorlando.com/document_dev/2019/02/13/OR-27-
0258%20SUMMARY _Redacted_1550075484532_19315571_verl.0.pdf
6
https ://www.ariando.gov/fi les/sha redassets/pu blic/v /1/initiatives/pu lse/pu lsehomicidereport_redacted. pdf
7
https://porta I.cops. usdoj .gov/resou rcecenter /ric/Pu blications/ cops-w0857-pu b.pdf
8
https ://va uIt. fb i.gov /pu lse-n ightcl ub-shooti ng-fbi-1 ab-ba 11 isties-report/ pu lse-nightcl ub-s h ooti ng-fbi-1 ab-ba 11 istics-
report-pa rt-01-of-0 1/vi ew
 VII. INTERVIEWS CONDUCTED

On October 24, 2023, a certified letter was sent to the law firm of Fulmer LeRoy & Albee, PLLC, the law
firm representing the Poma's in a civil premises liability case within the Ninth Judicial Circuit under 2018-
CA-006102 -O. This letter indicated my interest in conducting an interview with the Poma's to offer an
opportunity to respond to these allegations. This certified letter was received and stamped with the date
of November 8, 2023. On November 13, 2023, I spoke by phone with Michael LeRoy, who stated while
he would not be representing the Poma's in any potential criminal proceeding, he would make them
aware of my interest in conducting an interview. At the conclusion of th is investigation, the Poma's were
not ab le to be interviewed.

Numerous in person and over the phone interviews were conducted with individuals who submitted
sworn written statements. These interviews were consistent with their sworn written statements, and all
individuals desired to have an investigation conducted to determine any possible crimina l activity for this
incident against the Poma's. Many of the sworn written statements were obtained from individuals
residing outside of the United States and as a result, over the phone interviews were not able to be
conducted with these individuals.

Interviews were also conducted with City of Orlando Economic Development Deputy Director Timothy
Johnson, City of Orlando Econom ic Development Deputy Director Lillian Scott-Payne, Orlando Fire
Department Plans Examiner Chief Charles Howard, and OPD Police Range Master Scott Smith.

VIII. INV ESTIGATION - ALLEGATION ONE (1)

The first allegation against the Poma's was presented within Part Il l of 'They Knew" and titled, "Plans
Availability During Shooting." It was alleged the unavailability of building plans to first responders during
the three -hour long hostage situation, as law enforcement dealt with the chaos of navigating a dark
building with limited layout information and an active shooter, hampered response efforts. Below are the
responses to the allegations made within each specific subsection.

• 3.1 Email from Tisa Mitchell, " ... first responders ... did not have a layout of the building." While this
email does state one of the Pulse owners responded to the scene to hand draw a layout of the
building, there is no evid ence to support this statement.
• 3.2 No Building Layout: Chaos and Confusion Among First Responders. While it was alleged
response efforts were hampered by the lack of building plans, the detailed ana lysis of the actions
taken at Pulse and documented within "Rescue, Response, and Resilience - A critical incident
review of the Orlando public safety response to the attack on the Pulse nightclub" conducted by
the U.S. Department of Justice, Office of Community Oriented Policing Services, clearly indicates
otherwise. The below timetable documents the ongoing response efforts and highlights the
number of individuals rescued while law enforcement was still contending with a barricaded
gunman:

o Just before 2:00 a.m. The suspect parked a rented car in the parking lot of the neighboring
car shop, Pro Tint & Detailing, and walked south toward the Pulse nightclub .

o 2:02 a.m. The suspect, armed with a Sig Sauer MCX se miautomatic .223 caliber rifle
(mili tary-style rifle) and a Glock 17 (9mm) handgun, entered the Pulse nightclub through
the south door. He immediately shot a patron who wa s standing inside the front parlor.
o 2:02:17 a.m. An OPD detective working extra duty at the club reported on the Patrol East
radio channel: "Shots fired, shots fired, shots fired!" The police dispatcher immediately
broadcast a signal 43 (officer needs immediate assistance). At this point, the OPD
detective's exact location is unknown to the dispatcher and responding units.

o 2:02:35 a.m. The OPD detective reports "Shots fired 1912 S. Orange Ave. Shots fired,
multiple down!" Over the next one minute and nine seconds, the OPD detective made
three more radio transmissions, reporting that shots were being fired inside the club.

o 2:02 a.m. Dozens of the patrons inside Pulse ran out of the club through exits on the
south side of the club, through the main entrance, through a patio on the east side, and
into a fenced alleyway on the north side. One of the Pulse security officers kicked a hole
in the fence, which allowed approximately 20 patrons to escape into the parking lot of a
neighboring business to the north .

o 2:02 a.m. While taking protective cover behind a vehicle in the south parking lot, the OPD
detective fired several rounds at the suspect, who was standing just inside a set of double
doors and continued to fire multiple shots inside the club.

o 2:03 a.m. According to the OPD, less than one minute and 20 seconds after the signal 43
was broadcast, the first backup officer arrived on scene. A second backup officer arrived
about a minute later.

o 2:05 a.m. Over the radio, the OPD detective advised that the suspect had an assault rifle.
The OPD detective fired three shots at the suspect as the sound of rapid fire gunshots
were heard inside the club. The gunfire inside the club stopped.

o 2:06 a.m. The OPD detective assembled a contact team with three other officers and they
began to approach the club from the east patio area.

o 2:07 a.m. The OPD special weapons and tactics (SWA1) commander - a lieutenant who
was also the on -duty watch commander - arrived on scene.

o 2:08 a.m. A sergeant took the OPD detective's place on the initial contact team on the
east side of the club. A second contact team, located on the south side of the club, was
organized by the SWAT commander. The second team consisted of the SWAT commander
and five officers.

o 2:09 a.m. The contact team on the east patio directed a patron from the main dance floor
area out of the club through the patio, to South Orange Avenue. (Total individuals rescued
by law enforcement to this point: 1)

o 2:10 a.m. An officer from the contact team assisted a bartender who had been hiding
behind the patio bar since the shooting started. The bartender, who was not injured, was
directed out of the club to South Orange Avenue . At least five additional shots fired by
the suspect were heard further inside the club. The SWAT commander's team entered
the club through a large window they had broken. They moved toward the sound of the
gunshots. The officers believed the suspect had barricaded himself in one of two
restrooms at the end of a small hallway on the west side of the club . The team positioned
 itself behind a bar at the end of the hallway, keeping the suspect contained in the
restroom. One individual inside the north restroom called 911 advising that he was hiding
in the handicapped -accessible stall with at least 10 other people and that the suspect was
"in the bathroom. He's in the bathroom." At this point, the nature of the incident
transitioned to a barricaded suspect with hostages. No more gunshots were heard being
fired by the suspect until the final breach. (Total individu a ls rescued by law enforcement
to this point: 2)

o 2:14 a.m. On the other side of the club, two officers from the initial contact team located
a group of 22 patrons hiding in a restroom at the southeast corner of the main dance
floor. One officer provided cover while the other officer escorted the patrons out through
the east patio to awaiting officers . (Total individuals rescued by law enforcement to this
point: 24)

o 2:15 a.m. Officers found a person hiding behind a bar on the east patio and quickly helped
him out toward South Orange Avenue. (Total individuals rescued by law enforcement to
this point: 25)

o 2:15 a.m. At least seven people in the main dance floor area were quickly extracted
through the main entrance on the south side of the club or through the east patio to
waiting officers and deputies. (Total individuals rescued by law enforcement to this point:
at least 32)

o 2:17 a.m. The SWAT commander and sergeant in the west bar area fired shots at the
suspect. The SWAT commander was heard yelling ''Let me see your hands now!" just prior
to firing his weapon.

o 2:18 a.m. The SWAT commander asked dispatch to initiate a "full SWAT callout."

o 2:18-2:28 a.m. During this time, officers and deputie s moved through the main dance
floor area checking injured persons and looking for survivors. They helped at least 14
incapacitated individuals out of the club through the east patio or main entrance. (Total
individuals rescued by law enforcement to this point: at least 46)

o 2:21 a.m. A person who had been shot was able to escape from one of the west restrooms
and crawl out to the west bar, where he was helped ou t of the club by officers and moved
into the south parking lot area. (Total individuals rescued by law enforcement to this
point: at least 47)

o 2:25 a.m. Three officers extracted a person hiding in s id e a fenced -in storage area just
outside the double doors located on the south side of the club. (Total individuals rescued
by law enforcement to this point: at least 48)

o 2:30 a.m. An unidentified man, believed to be the suspect by the OPD, called 911, spoke
in a unknown language, and quickly hung up .

o 2:32 a.m. A se rgeant assisted by other officers rescued five people who were hiding in the
kitchenette behind the main bar. Two of the five were injure d and had to be carried out;
the other three, who could walk, were escorted out of t he club to the east patio and were
 handed off to officers and deputies . (Total individuals rescued by law enforcement to this
point: at least 53)

o 2:35 a.m . A sergeant and assisting officers rescued six people who were hiding in an
upstairs office area above the main dance floor. They were escorted across the dance
floor and out the east patio to awaiting officers and deputies. (Total individuals rescued
by law enforcement to this point: at least 59)

o 2:35 a.m. The suspect called 911 and told the call -taker that he "did the shooting in
Orlando.lJ The call lasted 50 seconds.

o 2:48 a.m. The crisis negotiation team (CNT} sergeant called the suspect back. The call
lasted six minutes. During the conversation, the suspect suggested he was wearing an
explosive vest and claimed there was a vehicle in the parking lot with explosives inside .

o 3:06 a.m. A person who had been shot and who had been hiding in one of the west
restrooms was able to crawl out to the west bar, where members of the SWAT team
rescued him and brought him to officers in the south parking lot. (Total individuals
rescued by law enforcement to this point: at least 60)

o 3:12 a.m. Additional members of the SWAT team arrived on scene and began relieving
officers and deputies inside the club.

o 3:13 a.m. OPD public information officers arrived on scene and began sharing information
on Twitter.

o 3:20 a.m. An OPD Avatar Ill Tactical Robot was sent into the club to provide images of the
urinal and south restroom, but it could only partially enter the restroom because of
obstructions. The OPD used the public address system on the robot to advise the hostages
that the police were working on a rescue.

o 3:25 a.m. After a report indicated that gunfire was heard in the lobby of Orlando Regional
Medical Center (ORMC} the hospital was locked down for approximately one hour and
implemented its "code silver/J active shooter plan.

o 3:42 a.m. SWAT members rescued four club workers who were hiding in the north
dressing room. (Total individuals rescued by law enforcement to this point: at least 64)

o 4:03 a.m. The OCSO hazardous device team (HDT) arrived on scene. A l<-9 from the
Greater Orlando Aviation Authority arrived on scene and alerted on the suspect's vehicle.

o 4:29 a.m. A person who was held hostage inside the club sent a text message to her
brother. She told her brother the suspect was going to attach four bomb vests to
hostages.

o Approx. 4:30 a.m . SWAT team officers rescued a group of eight patrons hiding in a
dressing room on the west side of the club, just north of the restrooms. They jarred an air
conditioning unit that was protruding from the exterior wall loose and directed the people
inside the dressing room to pull in the unit while SWAT team officers pushed it through
the opening. Once the unit was removed, SWAT team officers pulled eight people out of
 the dressing room through the hole in the wall. (Total individuals rescued by law
enforcement to this point: at least 72)

o 4:59 a.m. The OSCO HDT made final preparations for an explosive breach to the west wall.

o 5:02 a.m. The explosive charge was detonated; the wall was partially breached.

o 5:08 a.m. A SWAT team BEARCAT began to breach the west wall.

o 5:09 a.m. A SWAT team officer was heard on a loudspeaker telling people inside the club
to move away from the wall.

o 5:10-5:13 a.m. SWAT team members rescued people from the southwest restroom.
(Total individuals rescued by law enforcement to this point: at least 85}

o 5:14 a.m. As another SWAT officer was widening the hole in the south restroom wall, the
suspect began firing in the north restroom. The SWAT team deployed two flashbangs
(stun grenades) near the wall where the SWAT team was positioned .

o 5:15 a.m. SWAT team officers exchanged gunfire with the suspect, firing numerous
rounds. An OPD SWAT team officer was hit in his helmet by a round fired by the suspect.
The OPD reported the suspect was down after the exchange of gunfire.

o 5:17-5:26 a.m. People continued to be extricated from the club. An estimated total of 18
individuals were rescued from the restrooms by members of the SWAT team:
approximately 13 rescued from the south restroom before the suspect was killed and
approximately five rescued from the north restroom after he was killed.

o 5:27 a.m. All remaining individuals were extricated from the club and all of the hostages
who survived were rescued. Officers withdrew from the club because of the threat of
explosives. (Total individuals rescued by law enforcement to this point: at least 90)

o 11:15 a.m. The OPD SWAT, OCSO HDT, and Federal Bureau of Investigation SWAT team
officially determined the Pulse nightclub and the suspect' s vehicle were safe.
• 3.3 Acquiring Floor Plans is a Standard Practice . "They Knew" makes this statement based upon
an April 2008 article titled, ''Tactical Response and Operations Standard for Law Enforcement
Agencies," published by the National Tactical Officers Association. While OPD maintains and has
immediate access to floor plans of schools, hospitals, various churches, hospitals, malls, and public
venues, what is not maintained and not immediately available are floor plans of each and every
bar, nightclub, restaurant, or other commercial establishment located in the City of Orlando.
• 3.4 After the Shooting, City Officials Seek Building Plans. Presented are internal City of Orlando
email's concerning requests from media organizations about the existence of building plans at
Pulse .

IX. INVESTIGATION - ALLEGATION TWO (2)

The second allegation against the Poma' s was presented within Part II of "They Knew" and titled,
"Unpermitted Renovations." It was alleged unpermitted renovations and building modifications done to
the interior and exterior of Pulse were left unchecked and unregulated by the City of Orlando. Below are
the responses to the allegations made within each specific subsection.

• 2.1 Original Floor Plans: BLDG2003 -08240. Disclosed is an image of the approved and permitted
building plans for Pulse under BLDG2003 -08240 .
• 2.2 Before Photos: Interior of Pulse Prior to Most Unpermitted Renovations. Numerous
photographs from February of 2009 are presented depicting the inside of Pulse. It is alleged these
photographs document "illegal" renovations performed without the benefit of an approved
permit.
• 2.3 Violation: Patio Without a Permit (April 7, 2008). A complaint was submitted to City of Orlando
11
Code Enforcement in April of 2008 from an individual named lvr." It was alleged a new patio and
awning at Pulse were added without obtaining a permit. This complaint was adequately
addressed and cleared by the City of Orlando noting, "A permit was pulled back in 2004 for the
canopy/awning the permit number is BLD2004-05156." It does not appear the City of Orlando
addressed Pulse's fence, outdoor patio, bar, and seating areas.
• 2.4 Violation: Un permitted Bar. Presented is a complaint to City of Orlando Code Enforcement in
March of 2010 in which it was alleged Pulse built and installed a new bar without the proper
permitting. The inspector, "Bernard," cleared this complaint with the statement, "this person
complains about this property every week they have permits." This statement would be
inaccurate as there is no evidence Pulse obtained any such permit for a new bar.
• 2.5 Code Enforcement Incidents. This segment discloses a screen shot from a search of City of
Orlando Code Enforcement incidents at 1912 South Orange Avenue. From this screen shot, "They
Knew" opines the City of Orlando was aware of unpermitted renovations and failed to act against
Pulse . While "They Knew" states, "Correspondence sent from the City of Orlando to Rosario Poma
in 2010 addressed CUP violations but not the unpermitted interior and exterior renovations ... "
this would be an inaccurate statement as this correspondence was sent in 2004. In the 2004 letter
from the City of Orlando to Rosario Poma, the CUP violations were addressed, however all
renovations at this time were permitted under BLDG2003 -0824O. From the evidence obtained,
in 2010 when the City of Orlando became aware of the CUP violations and the unpermitted
renovations, no letter was sent to Rosario Poma when these issues were discovered.
• 2.6 Violation: Unpermitted Work (June 1, 2010). This segment addresses updates made on June
1, 2010, on the City of Orlando's internal database where activity for each parcel is monitored.
The entries document the need for Pulse to possibly add a fire protection system, additional
means of egress, and whether additional life safety features should be included. An entry is also
made stating any new work at Pulse will need to include all changes made to the interior and
exterior of Pulse.
• 2. 7 Pulse Advertises Renovations . "They Knew" disclosed advertising (allegedly dated June 25,
2010) obtained from Pulse's website in which Pulse announced changes to their lounge and
referenced having a dance floor.
• 2.8 Un permitted Floor Plans. Presented is information revealing an alleged email sent on May 20,
2010, from a Pulse employee to Timothy Johnson, the Division Manager of the Permitting Services
Division for the City of Orlando (the alleged email was not produced, and its authenticity has not
been verified). Within this email were architectural floor plans of changes made at Pulse. "They
Knew" highlights a total of fifteen (15) changes from the previously permitted changes made at
 Pulse under BLDG2003 -08240. Listed below are the historical changes to Pulse, highlighted in
three (3) images. The first image depicts the original floor plans from Pulse's approved CUP in
2003, the second image represents the approved and permitted floor plans under BLDG2003 -
08240, and the la st image documents the unapproved and unpermitted floor plans from 2010 .9

P RO JE CT () V J,: RV I r~ W &. ;\ N t\ LY S I S

f loor Plan

Dining
1\rl'"II

~·, <>utsidc • :: l ,. ..
.. , l'i1li11
f xlsting Uul lllintt

191 2 5out11 Ornnv,e Avenue

FLOOR PLANS APPROVED UNDER PULSE'S CUP

9
https ://www.ariando.gov/fi Ies/ sha redasset s/public/v / 1/i n iti ati ves/pu lse/pu lse_p Ian ningperm itti ngrecords. pdf
 i

: _,.,__ -j
. . -

~,~ ..,,..--...,_.~
·••- --
c:,·
l l • 11 '.1(•",Q ' 11,1. 1 ~r
I•• •'~ 'Il l_ ,1.-,1,;,,,,,. . .\',
11'1, 1: 1 ,

}' ~-•. o,:,:::.~--~··- .·_-::::-,:. ' ' . -..,,,, ,,.·

~ ·..::~·:::.~:=:~:~::::. .:. ~-• ~':./~!. ~\.'.:,... I~~~ 'f,';r:/:,:,~!-1, I
~

FLOOR PLANS APPROVED UNDER BLDG2003-08240

- - -•- - r - -,. , - - - - - - - - • - - - - - ' ' - - - -~

I ~:/
' I r \
._ . I .1·-_._ , ,, . ;j; .

r
11 ~- .: . ;

1··,
L ~-

w·, .. t·
iP
1 '~·:·

'-<
.:rj :
1:·,
' ll .

,,: ,·, 1
I
.:~- I
I 'I
I
.,
'. j
' '

ALLEGED UNAPPROVED AND UNPERMITTED FLOOR PLANS

 The City of Orlando Planning Division addressed the changes discovered between Pulse's original
CUP with Pulse's approved and permitted changes in BLDG2003 -08240, in Planning Director Dean
Grandin's May 12, 2004, letter to Rosario Poma. 10 While this letter requested Pulse to make the
necessary changes to either meet their original CUP or apply for a new CUP to be classified as a
nightclub, there is no evidence to show the City of Orlando ever enforced this issue. Additionally,
there is no evidence to show the City of Orlando ever formally notified Pulse in the form of a letter
regarding the unapproved and unpermitted floor plan changes implemented in 2010. There is
also no evidence to show Pulse ever retroactively obtained permits from the City of Orlando for
the 2010 changes to their floor plan.
• 2.9 After Photos: Pulse's Unpermitted Interior. This segment serves to present photographs taken
on March 11, 2015, during an inspection of Pulse by OFD. While "They Knew" states " ... these
photos also show some of the fire code violations that were overlooked during site visits," a
review of OFD's Occupancy Load Evaluation document for March 11, 2015 11 reveals the
11
statement, Today's visit completes occupant load evaluation. Photos taken during visit. Also
signed off few open issues during visit." This statement by OFD would indicate Pulse was following
applicable fire codes, and not in violation as "They Knew" alleges.
11
• 2.10 All Permits for 1912 S. Orange Avenue. "They Knew" declares, ... no permits allowed for
interior or exterior structural modifications after 2003, such as the outdoor patio bar, renovated
restrooms, a new interior bar, hallways, new walls, new exit doors, new rooms, and second story
accessible by ladder." A review of the permits obtained for 1912 South Orange Avenue confirms
this to be an accurate statement.
• 2.11 Scope of Work for BLD2010-00569. This section discloses a permit obtained by Pulse, BLD
2010-00659, to make non -structural changes to include replacing drywall and rotted wood, fix a
roof leak, and to remove and replace tile.
11
• 2.12 Fire Protection Review. "They Knew" makes the statement, ... a detailed review of fire
protection requirements is only performed when plans are submitted for permitting." This would
be an accurate statement as the City of Orlando Permitting Division is where permits are
submitted to and issued from. Fire plan reviews would be conducted concurrent with a submitted
permit application.
• 2.13 After Photos: Pulse After the Shooting. The following statement is made within this section:
11
Photos taken of Pulse after the shooting show numerous fire code violations, ADA compliance
issues, and the full scope of the unpermitted modifications done to the interior and exterior of
the building." "They Knew" further states multiple mistakes were made, and violations
11 11
discovered during inspections were routinely ignored. They Knew" also stated, ... photos of
Pulse nightclub (along with other records) show that the business was~ in violation of the
following ... " It is impossible to accurately assess the photographs presented as they were taken
after the shooting, and the original position of moved items is unknown. It is also impossible to
11
assign a percentage probability range to the subjective word, likely." The numerous photographs
presented do however document Pulse's floor plan which was in fact implemented without the
benefit of an approved permit.

10
https ://www.orlando.gov/fi les/sha redassets/pu blic/v /1/i n itiatives/pu lse/p ulse_pla n ni ngpermittingrecords .pdf
11
https ://www.orlando.gov/fi les/sha redassets/pu blic/v /1/i n itiatives/pu lse/p ulse_fi rei nspectionrecords 1. pdf
 • 2.14 Unpermitted Renovations: Obstacles for Escape. Within this segment, "They Knew" suggests
the "illegal" unpermitted renovations done to the interior and exterior of Pulse hindered the
escape of survivors. It is unable to be determined if these unpermitted changes directly caused
survivors to be unable to escape. It has been proven the actions of the gunman, Omar Mateen,
directly caused survivors to be unable to flee to safety. What is directly able to be established
from reviewing the FBl's Ballistic Report 12 for Pulse is Omar Mateen entered Pulse with 338 rounds
of ammunition. This consists of 9 magazines of 30 rounds of ammunition for each magazine
chambered in 5.56x4Smm/.223 caliber for Mateen's Sig Sauer MCX semiautomatic .223 caliber
rifle, and 4 magazines of 17 rounds of ammunition for each magazine chambered in 9mm caliber
for Mateen's Glock 17 handgun . At the conclusion of their investigation, the FBl's Ballistic Report
indicated the recovery of 9 magazines chambered in 5.56x45mm/.223 caliber and only 49 rounds
remaining, and the recovery of 4 magazines chambered in 9mm caliber and only 22 rounds
remaining. This would reveal Mateen expended 208 rounds of ammunition from his Sig Sauer
MCX semiautomatic .223 caliber rifle, and 59 rounds of ammunition from his Glock 17 handgun.
• 2.15 The Orlando Sentinel Reports on Exits and the Unpermitted Fence. Discussed extensively are
the unpermitted and uninspected (by the City of Orlando Planning Division) changes made to
Pulse in 2010.
• 2.16 DOJ Report Cites "Narrow Hallways" Interfered with Rescue. "They Knew" makes the
1
statement, "Throughout the report [' Rescue, Response and Resilience"] are references to
11
narrow hallways" which interfered with law enforcement being able to locate the shooter and
rescue victims," in addition to the statement, "The last approved floor plans of Pulse from 2003
show no hallways. All hallways that existed in the nightclub were constructed without permits.
1
Thus, these 'narrow hallways" were never inspected to ensure that they were in compliance with
building codes or that they met fire code standards." In reviewing "Rescue, Response and
Resilience," these two statements were located: "Upon entering the Adonis Room, they
determined the shots were coming from a narrow and dimly lit hallway," and "Command
personnel determined that an exterior breach offered a safer option than a direct assault down
1
the narrow hallway to rescue the hostages." While both statements do mention ' narrow" with
reference to hallways, the assumption they interfered with the tactical response to a barricaded
gunman located in a bathroom with opposing doorways at the end of a short hallway is inaccurate.
1
"They Knew" chooses to interpret 'narrow" with reference to the hallways as being narrower
than what is appropriate. While it is accurate the 2010 floor plan changes to Pulse were
unpermitted and uninspected by the City of Orlando Planning Division, it is unknown if the
hallways at Pulse were "narrow" or if in fact they were the appropriate width to meet applicable
building codes and fire standards. It has been established OFD consistently inspected Pulse, and
included hallways in their inspection criteria ensuring they were free of storage and unobstructed
for immediate use, and no violations were ever discovered. As a result, the allegations made
within this section are inaccurate, misleading, and erroneous.
• 2.17 Beaded Curtains: Another Violation Impeding Escape and Rescue. Discussed is the existence
of beaded curtains in certain doorways inside of Pulse. From the information provided, it is
unknown how many beaded curtains were inside of Pulse at the time of the shooting, how long

12
https://va LI It. fbi .gov /pLI ls e-n ightcl LI b-shooting-fbi -la b-ba 11 istics-report/pLilse -n ightclu b-shooti ng-fbi -lab-ba Ili stics-
report-part-01 -of-0 1/vi ew
 they were in existence, or if the beaded curtains obstructed actual exits or only internal doorways.
"They Knew" alleges these beaded curtains were in violation of Florida Fire Prevention Code
14.4.2.1 which states, "No furnishings, decorations, or other objects shall obstruct exits or their
access thereto, egress therefrom, or visibility thereof." A total of approximately one-hundred and
fifteen (115) inspections were conducted by OFD at Pulse between April of 2005 through May of
2016. No instances of OFD citing Pulse for having beaded curtains were discovered.
• 2.18 Media Inquiries About Unpermitted Work. Presented is an email between City of Orlando
11
employees Heather Fagan and Kyle Shepherd in which the fol lowing statement is made, The
owner [the Poma's] did not complete the necessary paperwork to obtain permits." This is a
completely accurate statement, and no evidence has been discovered indicating the Poma's ever
obtained the proper permits to make the floor plan changes at 1912 South Orange Avenue in
11
2010. In the third paragraph of this section, "They Knew" makes the statement, Records show
that the installation of required Life Safety Features was even cancelled by the Orlando Fire
Department in 2010 under the instruction of Timothy Johnson (Permitting Services), who also
claimed that new floorplans did not have to be submitted to OFD despite the known unpermitted
renovations and lack of building inspections." This would be an inaccurate statement with
reference to OFD cancelling required Life Safety Features and would have been done only by
Timothy Johnson in the latitude exercised under his responsibility as Division Director of
Permitting Services.
• 2.19 Citizens Questioned Impact of Unpermitted Renovations . This section represents several
emails from citizens questioning the unpermitted fencing at Pulse.
• 2.20 City of Orlando's Q&A Document. Presented is an internal City of Orlando document in which
a question -and -answer analysis regarding Pulse related issues are discussed. The issues
addressed include allegations of blocked exits, life -safety issues, the results of and different types
of fire inspections, occupancy levels, unpermitted work, and floor plans. I/They Knew" counters
each of the City of Orlando's statements and attempts to discredit these responses.

X. INVESTIGATION - ALLEGATION THREE (3)

The third allegation against the Poma's was presented within Part IV of I/They Knew" and titled,
11
0ccupancy Violations and Evidence Pulse was Over Capacity." It was alleged a history of occupancy
violations from public records and survivor accounts show Pulse was likely over capacity on June 12, 2016 .
Below a re the responses to the allegations made within each specific subsection.

• 4.1 OPD Officer Reports Overcrowding at Pulse (May 5, 2007). This refers to an email between
two (2) OFD personnel who reference an unknown female OPD officer who believes Pulse is
frequently overcrowded based on the volume of vehicles parked on Esther Street. The identity of
the female OPD officer who allegedly made the statement is unknown and this assertion is unable
to be verified.
• 4.2 Repeat Occupancy Violations and Notices. This section references 0FD inspections conducted
at Pulse. OFD notified Pulse it must maintain an accurate occupancy count, to include the use of
handheld clickers, and an occupancy load sign must be always po sted . This statement references
seven (7) instances in which OFD conducted inspections at Pulse and violations were discovered .
Among the documents provided by the complainants, a document titled, I/Permitting/Code
Enforcement/Planning/Fire/Life -Safety Timeline," was revi e wed . This specific document
 contained a chronological listing of all life -safety inspections conducted at 1912 South Orange
11
Avenue by OFD. While They Knew" chooses to highlight these seven (7) instances where
violations were discovered by OFD, what is not disclosed or discussed are the number of times in
which Pulse was inspected and no violations were observed . In looking at this data, between April
of 2005 and through May of 2016, OFD conducted approximately one -hundred and fifteen (115)
inspections at Pulse. Of these inspections, it was determined on approximately ninety-four (94)
occasions, there were no violations discovered, while it was determined on approximately
twenty-one (21) instances, violations were discovered. This data reveals Pulse had a violation
approximately 18% of the time and was in total compliance with life-safety inspections
11
approximately 82% of the time. The statements and accusations made within They Knew" in
reference to this topic are misleading and do not accurately reflect the status of Pulse being
compliant during unannounced OFD inspections approximately 82% of the time over an eleven
(11) year period.
• 4.3 History of Crowded Conditions at Pulse. Based purely on speculation, a former Pulse dancer
11
believed that on most nights," Pulse was filled with between 500 to 600 patrons and on high -
capacity nights, up to 800 people might be at Pulse. Multiple pictures of people on a dance floor
were included and allegedly obtained from social media. It is unknown if the pictures were taken
at Pulse and the reliability of this information cannot be relied upon.
• 4.4 Incident Report, Proper Protocol Not Being Followed (December 24, 2009). After an OFD
response to Pulse for a false fire alarm, crowded conditions were discovered and Pulse
management could not provide an accurate occupant count, nor was there evidence of a
ha ndheld clicker. This a Ilegation is accurate and is I isted on the "Permitting/Code
Enforcement/Planning/Fire/Life-Safety Timeline" document. A review of the narrative section for
this incident notes OFD adequately addressed the observed violation and advised Pulse of the
corrective action needed.
• 4.5 "321 People" initially reported inside of the club. Within a report by WFTV, it referenced 321
people allegedly being inside of Pulse at the time of the shooting. The FBI conducted the
investigation of this shooting, and it is unknown if a hand held clicker to monitor occupants was
ever recovered. While OPD did take photographs of the inside of Pulse post-shooting, these
photographs were taken after fill evidence had been removed by the FBI. As a result, it is
undetermined what the actual patron count was on June 12, 2016.
• 4.6 OnePULSE Foundation Designs Show Nightclub was Over Capacity. It is alleged Pulse was
overcapacity from a memorial design by adding the 268 reflective columns to honor survivors,
along with the 49 killed, to arrive at 317 occupants at the time of the shooting. It is uncertain the
validity of the 268 reflective column submissions, and as a result, this information cannot be relied
upon.
• 4.7 Communications Regarding Occupancy to be Vetted by City Attorney. This document merely
represents an email from OFD dated June 21, 2016, anticipating a request for documentation of
the occupancy level at Pulse .
• 4.8 Orlando Fire Department vs. Permitting Services. Within this document, OFD was requesting
a new set of floor plans during 2009 and 2010 to assist with recalculating Pulse's occupant load.
In reviewing OFD's fire inspection records at Pulse 13 , OFD determined on May 12, 2010, Pulse

13
https://www.orlando.gov/fi les/sha redassets/pu bl ic/v /1/i n itiatives/pu ls e/p ulse_fi rei nspectionrecords2.pdf
 needed to provide new floor plans to the City of Orlando's Permitting Division to assist with
occupant load evaluation. OFD was informed Pulse did not have to provide new floor plans based
on the authority of Timothy Johnson with the City of Orlando's Permitting Division. These
documents solidify OFD's ongoing involvement with addressing life-safety issues at Pulse.
• 4.9 Email from Fire Marshal Tammy Hughes. Within this email, 0FD Fire Marshal Tammy Hughes
speaks about the square footage of Pulse, the historical changes in the occupant load, the number
of exits, the date of the last OFD inspection which occurred on January 28, 2016, and the date of
the last OFD Company Officer exit check on May 21, 2016.
• 4 .10 Varying Occupancy Loads. The historical changes to the occupancy load at Pulse is
highlighted, and two (2) letters from the City of Orlando Office of the Fire Marshal are included.
These letters provided Pulse with their maximum occupant loads of 430 on April 20, 2009, and of
360 on May 14, 2010, indicating OFD was being conservative and lowering the number of patrons
allowed inside Pulse. Within both letters, OFD clearly states, ''As a reminder, it is the responsibility
of the owners and management to prevent overcrowding ... " These letters, in addition to the
historical list of actions taken by OFD within, "Permitting/Code Enforcement/Planning/Fire/Life-
Safety Timeline," show OFD was actively involved in monitoring life-safety issues at Pulse.

XI. INVESTIGATION - ALLEGATION FOUR (4)

The fourth allegation against the Poma's was presented within Part I of "They Knew" and titled,
"Operating in Violation of Conditional Use Permit." It was alleged Pulse operated for years in violation of
their conditional use permit which allowed their business to operate as a restaurant and martini bar with
strict written limitations and not as a nightclub. Below are the responses to the allegations made within
each specific subsection.

• 1.1 CUP2003 -00012: Approval for Restaurant and Martini Bar. These records show the Poma's
application to the City of Orlando's Municipal Planning Board with a request to open a martini bar
/ restaurant at 1912 South Orange Avenue. This application was approved under Conditional Use
Permit (CUP) 2003 -00012 on July 15, 2003. The Poma's were required to obtain a CUP for this
address as it was anticipated the sales of alcoholic beverages would exceed 49% of gross revenues
while being located within 1,000 feet from a church. Within their CUP application, the Poma's
submitted a floor plan which shows three (3) dining areas, in addition to a sample menu.
Information is also presented showing on November 18, 2003, Pulse submitted building plans
submitted for interior modifications and received an early start authorization issued under
BLD2003 -08240. A permit for these modifications was issued to Pulse on January 28, 2004 .
• 1.2 Violations Documented by the City of Orlando . This segment contains a document obtained
from the City of Orlando's Pulse Tragedy Public Records website. 14 This informative document
(Pulse Code Enforcement Record Pre 6-12 (pages 134-136)) prepared by the City of Orlando
(presumably in 2010) highlights property information, notable conditions of the conditional use
approval, issues with the approved conditional use permit, issues with unpermitted exterior
improvements to the site, existing parcel tags, permit history, and next steps. This document
within "They Knew" fails to include the chronological permit history disclosed on the City of

14
https://www.orlando.gov/fi les/sha redassets/pu blic/v /1/initiatives/pu lse/p uls e_pla n ni ngpermittingrecords. pdf
 11
Orlando's website. It is unknown why They Knew" would omit this significant and important
information.
11
• 1.3 Email from Jason Burton: The CUP was approved for a restaurant, not a nightclub." This
section documents the City of Orlando's determination Pulse was operating outside of their CUP
for a martini bar/ restaurant and was conducting business as a nightclub.
• 1.4 Letter to Rosario Poma from the City of Orlando. Within this portion, an email in July of 2010
is disclosed where the City of Orlando notifies Rosario Poma of their interest in meeting to discuss
the previously approved CUP and exterior modifications to 1912 South Orange Avenue.
• 1.5 Letter from Dean Grandin, "Significant change in use to that approved by the Municipal
Planning Board." A letter dated May 12, 2004, from the City of Orlando to Rosario Poma is
included and the Poma's are notified they are operating outside of their approved CUP. The
Poma's are informed of several options to gain compliance which would be to initiate a new
application for a CUP for a nightclub, or to comply with their original CUP. The Poma's are also
11
informed, ... the ground floor building wall facing the street must contain a minimum of 15
percent transparent materials, located between 3 and 7 feet measured from the ground level;
furthermore, at least one public entrance must be oriented toward the street." This letter
highlights the City of Orlando's active involvement in monitoring how Pulse was conducting their
business, and the steps taken to have the Poma's gain compliance. "They Knew" also alleges the
lack of proper windows encumbered escape and rescue with the statement, "If the required
windows existed at the time of the shooting, law enforcement officers would have had additional
entry points to the building, as well as spaces through which to visualize the layout of the building
and the locations of hostages and the shooter during the three -hour long incident." This
conditional assertion is entirely speculation and should not be entertained.
• 1.6 Rosario Poma Tells City He Will Remove Dance Floor. In response to the City of Orlando's May
12, 2004, letter, Rosario Poma states in a letter dated May 13, 2004, he will submit revised plans
for the front of Pulse facing South Orange Avenue with 15% transparency in a manner acceptable
to the City of Orlando and will remove a dance floor. At no point does Poma acknowledge or
address the City of Orlando's request for a new CUP to comply with Pulse operating in practice as
a nightclub, instead of as a martini bar/ restaurant, which Pulse was approved for. "They Knew"
makes an assumption when it states, "Furthermore, the main dance floor, which was in violation
of the business's conditional use permit, was where most victims were shot and murdered. Had
the laws been enforced, people would not have been congregating in this space while dancing to
the DJ's music." This premise is incorrect, is not a rational conclusion, and should be dismissed.
• 1.7 "Dance Hall" Added to Business Tax Application. Numerous documents are presented from
2005, 2008, 2009, and 2010 in which Pulse acknowledges having a dance floor, which is contrary
to Rosario Poma's May 13, 2004, letter where he stated Pulse would be removing their dance
floor.
• 1.8 Regular Cover Charges Were in Violation of CUP2003 -00012. This document highlights an
alleged advertisement from Pulse in 2007 when they charged admission fees. Per their CUP,
'' ... cover charges and entry fees may only be collected on an occasional basis for special events
11
such as live entertainment." Despite the wording Nightly Eve nts" on the advertisement, it is
unknown if this was for a special event or how frequently admission fees were charged .
• 1.9 Transportation Engineer Review (May 21, 2003). In a May 21, 2003, review of the parking lot
at 1912 South Orange Avenue (performed before Pulse rece ived their CUP), a transportation
 engineer for the City of Orlando identified the potential need for changes to the parking lot. It
was recommended if in the future Pulse is substantially/ significantly enlarged or improved, other
changes to the parking lot will be required per City Code for properties accessing from a
thoroughfare street such as Orange Avenue .
• 1.10 Violation: Operating as a Bar/Nightclub. Evidence is presented in which an unknown
individual named "Hanna" submitted a complaint in 2010 to the City of Orlando's Code
Enforcement Division alleging Pulse did not have a permit for their bar. This complaint was
cleared by Code Enforcement referencing Pulse's CUP and their alcohol license (ABL2004-00057).
• 1.11 Violation: Conditional Use Permit. In a complaint to the Code Enforcement Division from an
individual listed as "Guest," it was alleged Pulse was operating as a nightclub and outside of their
CUP. While Code Enforcement Inspector ''Bernard" closed out this complaint by stating, "This
establishment received full approval from the City to open as a nightclub in 2003," this statement
is inaccurate.
• 1.12 Zoning Incident #433805 (June 21, 2016). This represents an opened Code Enforcement
incident post-shooting and has no relevance to this investigation.

XII. INVESTIGATION - ALLEGATION FIVE (5)

The fifth allegation against the Poma's was presented within Part V of "They Knew" and titled, "Other
Issues with Security and Risk Management ." Below are the responses to the allegations made within each
specific subsection.

• 5.1 Letter to City: "We have no money to install such an elaborate system at this time.'' This
segment discloses an April 8, 2009, letter from a Pulse representative to City of Orlando Fire
Marshal Tammy Hughes requesting an additional year to install a new fire alarm system. It is
unknown from the documentation available if the addition of a Voice Evacuation System installed
with the permit under FIR2009-01036 was done in lieu of obtaining a sprinkler system.
• 5.2 Fire Alarm Cancellation and Interior Modifications. In a letter dated June 1, 2010, Millennium
Fire and Security, Inc., notifies City of Orlando Fire Marshal Tammy Hughes, Pulse has cancelled
their monitoring contract, and altered the building at 1912 South Orange Avenue.
• 5.3 City of Orlando to Rosario Poma: "You must provide safety for your customers." In a
handwritten note by an unknown author on an unknown date, a City of Orlando official informed
Pulse they shall provide a signed and dated contract from a lice nsed alarm company within 30
days. Upon receipt of this contract, the City of Orlando agreed to provide Pulse a time limit for
all work to be completed, in addition to a reminder whereby Pulse must provide safety for their
customers and continue to work with OPD on site. This note is informational only for Pulse and
has no investigative value .
• 5.4 City's Notes with Rosario Poma (August 6, 2010). A handwritt e n note from August 6, 2010, by
an unknown City of Orlando employee during a meeting with Rosario Poma, details various steps
taken by Pulse. The notes state Pulse has secured additional off-site parking, Pulse is being
blamed for disturbances which are not their fault, they have hire d additional police for security,
and have been in business for six years and have done a great deal of improvements. "They Knew"
attempts to critique Pulse's efforts by stating, "Video surveillance footage shows the shooter
walking right into the nightclub around 2:02 am [with a] Sig Sauer MCX semi-automatic .223
caliber rifle and a Glock 17 9 mm handgun - without being stopped by security." It is unknown if
 "They l<new" is implying the Pulse shooter would have been stopped from entering had there
been additional police present. Too many unknown answers exist to adequately address this
11
entirely speculative statement made by They Knew" and as a result, no cause -and -effect analysis
should be attempted.
• 5.5 Neighborhood Meeting About Pulse and letter to Mayor Daley. In May of 2010, OPD and
Rosario Poma met with residents from the neighborhood around Pulse to address complaints
stemming from the behavior of Pulse patrons. A letter to Mayor Dyer dated October 24, 2016,
from a neighbor of Pulse who complained about the behaviorofpulse patrons, was also included.
• 5.6 Poma's lawyer, Gus Benitez, requests Orlando Fire Department Records. In an email dated
June 21, 2016, Pulse attorney Gus Benitez requested from 0FD all inspection reports and any
other documents from the three months prior to the June 12, 2016, shooting. "They Knew" states
this email suggests Pulse was not in compliance with Florida Fire Protection Code: 10.2.5, whereby
an owner of a building shall keep records of all maintenance, inspections, and testing of all fire
related protection systems. This is entirely speculation and should not be given any further
attention.
• 5.7 Blocked, Locked, and Improperly Functioning Doors and Obstructed Exits. Presented is a
document from OFD dated May 21, 2016, and detailing an exit check performed at Pulse. Box#
7, "Exit Door or Hardware Inoperable" is checked, and an open box is checked with a handwritten
note stating, "Fire Extinguisher not hanging." Also presented is a printout from an internal OFD
software system presumably used to track inspections. In the comments section of the May 21,
2016, inspection entry is the statement, "DOORS ARE INOPERABLE." This discrepancy was
assigned for follow-up on June 5, 2016, with follow-up to be completed by July 1, 2016. With the
Pulse shooting taking place on June 12, 2016, subsequent follow- up on this discrepancy was not
11
performed. They Knew" also introduced four (4) previous 0FD exit check documents in which
exit violations were discovered at Pulse. A review of OFD's fire inspection records reveals Pulse
either remedied the violation while OFD was on site or fixed a violation prior to a subsequent
inspection. 15
XIII. CONCLUSION

In conducting this investigation, a thorough and comprehensive review was conducted on all evidence
presented by the complainants. Several previous investigations into the June 12, 2016, mass shooting at
Pulse have been conducted. The primary investigation was conducted by the FBI however this
investigation is not public-record and was not available for review. The investigation conducted by OPD
documented the timeline of actions taken by responding officers from the initial shooting, and through
the final exchange of gunfire with the shooter. The investigation conducted by the FDLE focused on the
use of deadly force by OPD and the Orange County Sheriff's Office. The internal investigation conducted
by OPD focused on policy compliance. The common determination from these competent and well -
documented investigations was this shooting was perpetrated by Omar Mateen. The FBI concluded this
was a terrorist attack, and significant evidence exists to show Mateen conducted this attack in support of
1515 (Islamic State of Iraq and Syria).
11
The first allegation against the Poma's within They Knew," stated the unavailability of building plans to
first responders during the three -hour long hostage situation, as law enforcement dealt with the chaos of

15
https ://www.ariando.gov/fi les/sha redassets/pu bl ic/v /1/i nitiatives/pu lse/pu lse_fi rei nspection records 2. pdf
navigating a dark building with limited layout information and an act ive shooter, hampered response
efforts. This investigation determined no actual or up to date floor plans for Pulse were ever available to
first responders. While OPD has immediate access to floor plans of schools, hospitals, various churches,
hospitals, malls, and public venues, what is not maintained and not immediately available on a Sunday
morning at approximately 0200 hours are floor plans of every bar, nightclub, restaurant, or other
commercial establishment located in the City of Orlando. Having floor plans would be ideal and the
perfect scenario for any tactical response, however this did not mean law enforcement stopped their
response efforts at Pulse . Despite not having current floor plans, OPD Detective Adam Gruler, who had
worked in an off-duty capacity at Pulse for approximately a year and a half to two years, was on scene
and was familiar with the layout of the building. Detective Gruler was able to provide accurate floor plan
information to OPD Lieutenant Scott Smith who led the response efforts. Within their comprehensive
after-action report titled, "Rescue, Response, and Resilience," the U.S. Department of Justice, Office of
Community Oriented Policing Services, ultimately determined Omar Mateen stopped discharging his
firearms at 0210 hours, and by 0527 hours, when Mateen was shot and killed, a total of at least ninety
(90} individuals had been rescued by law enforcement from within Pulse. As a result, the evidence
reviewed and obtained shows the lack of accurate and up to date floor plans at Pulse did not hamper the
law enforcement response to a terrorist attack.

With reference to the second allegation within "They Knew" in which it was alleged unpermitted
renovations and building modifications done to the interior and exterior of Pulse were unchecked and
unregulated by the City of Orlando, it was determined Pulse did make unpermitted renovations to both
their inside and outside. Evidence shows the Poma's received approval from the City of Orlando's
Municipal Planning Board to open a martini bar/ restaurant under CUP 2003 -00012 on July 15, 2003. The
floor plans approved with this CUP show what appears to be a restaurant, however in the floor plans
approved for Pulse under BLDG2003 -08240 on November 11, 2003, the floor plans are significantly
different than those under their approved CUP and look much more like a nightclub. Upon discovering
this difference, the City of Orlando's Permitting Division notified Pulse in writing they could initiate a new
application for a CUP for a nightclub or comply with their original CUP . Pulse did not comply with either
option and continued to operate as a nightclub . In May of 2010, Pulse submitted updated floor plans to
the City of Orlando's Permitting Division with significant changes to their interior and exterior, but never
obtained a permit to make these changes. No evidence was uncovered indicating the City of Orlando's
Permitting Division ever made Pulse obtain a permit retroactively for these changes.

In their third allegation, "They Knew" attempted to show Pulse had a history of occupancy violations from
public records and survivor records indicating the nightclub was likely over capacity on the night of the
shooting. Evidence was uncovered indicating Pulse was inspected by 0FD on a regular basis and while
there were instances of Pulse not utilizing a hand -held checker to monitor capacity, it was proven Pulse
was compliant during 82% of OFD's unannounced inspections between 2005 and 2016. Any violations
were addressed by Pulse while OFD was on scene, and of those unable to be immediately addressed, a
follow up inspection was conducted to ensure compliance . The exact number of occupants inside Pulse
on the night of June 12, 2016, is unable to be accurately determined. The FBI would be in possession of
the hand -held clicker (if one exists) used to monitor the patron count. This item is not available to be
reviewed and was removed from inside of Pulse prior to the photograph s taken by OPD. As a result, the
exact number of patrons inside of Pulse at the time of the shooting is unable to be accurately established.
When addressing the fourth allegation made by "They Knew," significant evidence was uncovered to
support this claim. It was alleged Pulse operated in violation of their conditional use permit, which
allowed the business to operate as a restaurant and martini bar with strict written limitations and not as
a nightclub/dance hall. It has been established Pulse received a conditional use permit (CUP} from the
City of Orlando Municipal Planning Board to operate as a martini bar/ restaurant on July 15, 2003. In
obtaining their CUP, floor plans were submitted with their application which clearly shows three (3) dining
areas. On November 18, 2003, Pulse submitted and received approva l from the City of Orlando to amend
their floor plans under BLDG2003 -08240. Upon discovery of the difference between the floor plans
approved under Pulse's CUP with the floor plans approved under BLDG20O3-08240, a letter from the City
of Orlando was sent to Rosario Poma on May 12, 2004. This letter informed Pulse they could make the
necessary changes to either meet their original CUP or apply for a new CUP to be classified as a nightclub.
Pulse took no action with this request from the City of Orlando and moved ahead with their intention of
operating Pulse as a nightclub. When the City of Orlando was made aware of the interior and exterior
changes to Pulse in 2010, it does not appear any action was taken by the City of Orlando in addressing
these changes.

In their last allegation, "They Knew" alleged there were other general failures in security and risk
management at Pulse. The issues raised within this specific allegation center around a sprinkler system/
voice evacuation system for fire purposes, the relationship between Pulse and those in the neighboring
community, the direct entry by Omar Mateen into Pulse without being stopped by security, and the
possibility there were blocked, locked, and improperly functioning doors and obstructed exits. With
reference to the direct entry by Omar Mateen into Pulse, too many unknowns exist to be able to
definitively answer how entry was able to be made. In addressing the issue with the doors and exits at
Pulse and discovered during OFD's May 21, 2016, inspection, follow-up inspection was assigned on June
5, 2016, with a completion date set for July 1, 2016. With the shooting taking place on June 12, 2016, OFD
was unable to complete their follow-up inspection and as a result, it is unknown if Pulse remedied this
violation prior to this shooting or which door OFD was referring to as it was not specified during their
inspection.
11
They Knew" introduced evidence the complainants believe supported the Poma's being criminally
charged with F.S. 782.07-3, Involuntary Manslaughter by Culpable Negligence which would need to be
proven beyond a reasonable doubt. This statute is comprised of two (2) elements with the first
requirement being a victim is dead. This part of the statute is satisfied and t here is no statute of limitations
issue as a prosecution for a felony resulting in death may be commenced at any time as noted in Florida
Statute 775.15(1). 16 The second part this statute, ''The death of (victim) was caused by the culpable
negligence of (defendant)," is not able to be established from the evidence obtained and reviewed. As
11
explained within the jury instructions for this statute, culpable negligence is defined as, ... for negligence
to be culpable, it must be gross and flagrant. Culpable negligence is a course of conduct showing reckles s
disregard of human life, or of the safety of persons exposed to its dangerous effects, or such an entire
want of care as to raise a presumption of a conscious indifference to consequences, or which shows
wantonness or recklessness, or a grossly careless disregard for the safety and welfare of the public, or
suc h an indiffere nce to th e rights of others as is equivalent to an intent ional violation of suc h rights . The
negligent act or omission must have bee n committed with an utter disregard for the safety of others.

16
http ://www .leg.state .fl.u s/statut es/ind ex.cfm ?App_ mod e=Display _Statute&Search_Stri ng=&URL=0700-
0799/0775/Section s/0775 .15. html
Culpable negligence is consciously doing an act or following a course of conduct that the defendant must
have known, or reasonably should have known, was likely to cause death or great bodily injury."

None of the actions by the Po ma's with reference to the unpermitted changes to their floor plans, or their
alleged inattention towards their doors and exits were done with a reckless disregard of human life or
with an utter disregard for the safety of others. The Poma's could not have reasonably foreseen or
anticipated a terrorist incident taking place at Pulse. Omar Mateen, who possessed both an assault rifle
and a semi-automatic handgun, discharged his firearms approximately 267 times, resulting in the deaths
of forty-nine (49) people and the wounding of fifty-three (53) other individuals.

Even if every alleged violation of building and fire codes at Pulse were provable beyond a reasonable
doubt and even if it could be proven some of the victims killed at Pulse by Mateen would have survived if
it were not for these alleged building and fire code violations, the wrongdoing of Mateen is legally an
independent intervening act which supersedes any possible criminal liability the Poma's could have had
for any of the deaths. It has been well established under case law in the State of Florida the independent
acts of third persons can break the required chain between the death of a victim and the culpable
negligence of a defendant and constitute an independent intervening act for which the defendant cannot
be held criminally liable. Hodges v. State, 661 So. 2d 107 (Fla. 3d DCA 1995).

As a result of the evidence obtained, probable cause does not exist to charge the Poma's with F.S. 782.07-
3, Involuntary Manslaughter by Culpable Negligence, and this investigation should be considered CLOSED.
 I swear/affirm the above statements are correct Sworn to and subscribed before me, the undersigned
and true.
authority, this 1st day of August 2024.

/ v
Signature

~ Law Enforcement Officer

Orlando PD Emp. # }1, 61 I
Michael Stanley 14767

Name and Employee Numbe □ Notary Public

□ Personally Known □ Produced Identification