Cit!. ol
Sonto
Monico
CITY OF SANTA MONICA
CALIFORNIA LEVINE ACT DISCLOSURE
The Levine Act prohibits City Officers from participating in any action related to a contract, license, permit, or entitlement if such Offlcer received campaign contributions totaling more than $500 within the previous twelve months, and for twelve months following the date of a final decision, from a party or participant to the proceeding, or their agent.
Section 84308(a)(4) of the Levine Act defines an "Officer" as follows: "Officer" means any elected or appointed officer of an agency, any alternate to an elected or appointed officer of an agency, and any candidate for elective office in an agency. The term "Officer" is further defined 2 Cal.
Code Regs. Section 18438.'1, which states:
An officer of an agency includes only those persons who make, participate in making, or in any way attempt to use their official position to influence a decision in the license, permit, or entitlement for use proceeding, or who exercise authority or budgetary control over the agency or officers who may do so, and:
(1) Serve in an elected position, including an official appointed to an elected position due to an interim vacancy or an election otherwise canceled because the official was the sole candidate for the oosition:
(2) Serve as a member of a board or commission;
(3) Serve as the chief executive of a state agency, or county, city or district of any kind; or (4) Have decision making authority with respecl to the proceeding involving a license, Dermit. or other entitlement for use and is also a candidate for elected ofiice or has been a candidate for elective office in the '12 months prior to the proceeding.
A list of Santa Monica Elected Officials and members of boards and commissions can be found at the following links. The party making this certification is responsible for determining whether a recipient of a political contribution is a City Officer prior to completing this form. httos://www.smqov.net/deoartments/council/
https://wwwsantamonica.oov/deoartments/rent-control
httos://wwwsmqov.net/boards/
Have you, your company, or any agent on behalf of you or your company, made any political contributions of more than $500 to any City Officer in the twelve months preceding the date of the submission of your application or proposal? L-l veslglrvo
Name of Councilmember or Citv Officer:
Name of Contributor:
Date(s) of Contribution(s):
Amount(s)
Please specify below and/or add additional sheet(s) to identify additional Councilmembers or City Officers to whom you and/or your agents made campalgn contributions.
Citv of Santa Monica Levine Act Disclosure Form
ia Sioned: )<+-,,
print Name: Satish Patel, M.D.
Clty ot
Sdnto
Monicq
Answering YES does not preclude the City of Santa Monica from awarding a contract, license, permit, or entitlement or taking any subsequent action related to the item. lt does, however, preclude the identified City Officer from participating in any actions related to such item.
By signing below, you certify you also agree to disclose to the City any future contributions made to Councilmembers or other City Officers by you or your agent(s) after the date of signing this disclosure form, and within 12 months following the approval, renewal, or extension of the requested contract, license, permit' or entitlement.
I HEREBY CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIATHAT THE FOREGOING IS TRUEAND CORRECT.
e"1"' June 16,2025
t,,,". Physician/Partner
Company: Pacific Harbor Medical Group
Additional Disclosures:
Please note this form is a public record and subject to a California Public Records Act requestCitv of Santa Monica Levine Act Disclosure Form