Katherine Lewis v. ADP Technology Services, Inc.

• Court: District Court, C.D. California
• Decided: June 23, 2023
• Docket: 2:23-cv-02583
• Status: Unknown

Opinion

1 2 3 4 5 6 7 UNITED STATES DISTRICT COURT 8 CENTRAL DISTRICT OF CALIFORNIA

KATHERINE LEWIS, an individual, 10 , Case No. 2:23-cv-02583-SPG-PD Plaintiff, v. STIPULATED PROTECTIVE 12 ORDER ADP TECHNOLOGY SERVICES, 13 INC., a Delaware corporation; and DOES 1-50 inclusive, 14 Defendant. 15 16 i7 || 1. A,PURPOSES AND LIMITATIONS 18 Discovery in this action is likely to involve production of confidential, 19 || proprietary, or private information for which special protection from public 29 || disclosure and from use for any purpose other than prosecuting this litigation may be 21 || warranted. Accordingly, the parties hereby stipulate to and petition the Court to enter 22 || the following Stipulated Protective Order. The parties acknowledge that this Order 23 || does not confer blanket protections on all disclosures or responses to discovery and 24 || that the protection it affords from public disclosure and use extends only to the 25 || limited information or items that are entitled to confidential treatment under the 26 || applicable legal principles. 27 B. GOOD CAUSE STATEMENT 28 This action is likely to involve confidential, proprietary, and/or financial

1 || information for which special protection from public disclosure and from use for any 2 || purpose other than prosecution of this action is warranted. Such confidential and 3 || proprietary materials and information consist of, among other things, confidential 4 || business or financial information, information regarding confidential business 5 || practices, or other confidential research, development, or commercial information 6 || (including information implicating privacy rights of third parties), sensitive medical 7 || information, compensation information about third parties, information regarding g || confidential compensation policies and procedures, and information otherwise 9 || generally unavailable to the public, or which may be privileged or otherwise 10 || protected from disclosure under state or federal statutes, court rules, case decisions, 11 || or common law. Accordingly, to expedite the flow of information, to facilitate the 12 || prompt resolution of disputes over confidentiality of discovery materials, to 13 || adequately protect information the parties are entitled to keep confidential, to ensure 14 || that the parties are permitted reasonable necessary uses of such material in 15 || preparation for and in the conduct of trial, to address their handling at the end of the 16 || litigation, and serve the ends of justice, a protective order for such information is 17 || justified in this matter. It is the intent of the parties that information will not be 18 || designated as confidential for tactical reasons and that nothing be so designated 19 || without a good faith belief that it has been maintained in a confidential, non-public 20 || manner, and there is good cause why it should not be part of the public record of this 21 case. 22 C. ACKNOWLEDGMENT OF PROCEDURE FOR FILING UNDER SEAL 23 The parties further acknowledge, as set forth in Section 12.3, below, that this 24 || Stipulated Protective Order does not entitle them to file confidential information 25 || under seal: Local Civil Rule 79-5 sets forth the procedures that must be followed and 26 || the standards that will be applied when a party seeks permission from the court to 27 || file material under seal. 28

1 There is a strong presumption that the public has a right of access to judicial 2 || proceedings and records in civil cases. In connection with non-dispositive motions, 3 || good cause must be shown to support a filing under seal. See Kamakana v. City and 4 || County of Honolulu, 447 F.3d 1172, 1176 (9th Cir. 2006), Phillips v. Gen. Motors 5 || Corp., 307 F.3d 1206, 1210-11 (9th Cir. 2002), Makar-Welbon v. Sony Electrics, 6 || Inc., 187 F.R.D. 576, 577 (E.D. Wis. 1999) (even stipulated protective orders require 7 || good cause showing), and a specific showing of good cause or compelling reasons g || with proper evidentiary support and legal justification, must be made with respect to 9 || Protected Material that a party seeks to file under seal. The parties’ mere designation 10 || of Disclosure or Discovery Material as CONFIDENTIAL does not—without the 11 || submission of competent evidence by declaration, establishing that the material 12 || sought to be filed under seal qualifies as confidential, privileged, or otherwise 13 || protectable—constitute good cause. 14 Further, if a party requests sealing related to a dispositive motion or trial, then 15 || compelling reasons, not only good cause, for the sealing must be shown, and the 16 || relief sought shall be narrowly tailored to serve the specific interest to be protected. 17 || See Pintos v. Pacific Creditors Ass’n, 605 F.3d 665, 677-79 (9th Cir. 2010). For each 18 || 1tem or type of information, document, or thing sought to be filed or introduced under 19 || seal in connection with a dispositive motion or tnal, the party seeking protection 20 || must articulate compelling reasons, supported by specific facts and legal 21 || justification, for the requested sealing order. Again, competent evidence supporting 22 || the application to file documents under seal must be provided by declaration. 23 Any document that is not confidential, privileged, or otherwise protectable in 24 || its entirety will not be filed under seal if the confidential portions can be redacted. If 25 || documents can be redacted, then a redacted version for public viewing, omitting only 26 || the confidential, privileged, or otherwise protectable portions of the document, shall 27 || be filed. Any application that seeks to file documents under seal in their entirety 28 || should include an explanation of why redaction is not feasible.

1 2 || 2. DEFINITIONS 3 2.1 Action: Katherine Lewis v. ADP Technology Services, Inc. et 4 || al. (Case No. 2:23-cv-02583- SPG-PD). 5 2.2 Challenging Party: a Party or Non-Party that challenges 6 || the designation of information or items under this Order. 7 2.3. “CONFIDENTIAL” Information or Items: information (regardless of 8 || how it is generated, stored or maintained) or tangible things that qualify for 9 || protection under Federal Rule of Civil Procedure 26(c), and as specified above in the 10 || Good Cause Statement. 1] 2.4 Counsel: Outside Counsel of Record and House Counsel (as well as 12 || their support staff). 13 2.5 Designating Party: a Party or Non-Party that designates information or 14 || items that it produces in disclosures or in responses to discovery as IS || “CONFIDENTIAL.” 16 2.6 Disclosure or Discovery Material: all items or information, regardless 17 || of the medium or manner in which it is generated, stored, or maintained (including, 18 || among other things, testimony, transcripts, and tangible things), that are produced or 19 || generated in disclosures or responses to discovery in this matter. 20 2.7 Expert: a person with specialized knowledge or experience in a matter 21 || pertinent to the litigation who has been retained by a Party or its counsel to serve as 22 || an expert witness or as a consultant in this Action. 23 2.8 House Counsel: attorneys who are employees of a party to this Action. 24 || House Counsel does not include Outside Counsel of Record or any other outside 25 counsel. 26 2.9 Non-Party: any natural person, partnership, corporation, association, or 27 || other legal entity not named as a Party to this action. 28

1 2.10 Outside Counsel of Record: attorneys who are not employees ofa party 2 || to this Action but are retained to represent or advise a party to this Action and have 3 || appeared in this Action on behalf of that party or are affiliated with a law firm which 4 || has appeared on behalf of that party, and includes support staff. 5 2.11 Party: any party to this Action, including all of its officers, directors, 6 || employees, consultants, retained experts, and Outside Counsel of Record (and their 7 || support staffs). 8 2.12 Producing Party: a Party or Non-Party that produces Disclosure or 9 || Discovery Material in this Action. 10 2.13 Professional Vendors: persons or entities that provide _ litigation 11 || support services (e.g., photocopying, videotaping, translating, preparing exhibits or 12 || demonstrations, and organizing, storing, or retrieving data in any form or medium) 13 || and their employees and subcontractors. 14 2.14 Protected Material: any Disclosure or Discovery Material that is 15 || designated as “CONFIDENTIAL.” 16 2.15 Receiving Party: a Party that receives Disclosure or Discovery Material 17 || from a Producing Party. 18 i9 || 3. SCOPE 20 The protections conferred by this Stipulation and Order cover not only 21 || Protected Material (as defined above), but also (1) any information copied or 22 || extracted from Protected Material: (2) all copies, excerpts, summaries, or 23 || compilations of Protected Material; and (3) any testimony, conversations, or 24 || presentations by Parties or their Counsel that might reveal Protected Material. 25 Any use of Protected Material at trial shall be governed by the orders of the 26 || trial judge. This Order does not govern the use of Protected Material at trial. 27 || 4. DURATION 28

1 FINAL DISPOSITION of the action is defined as the conclusion of any 2 || appellate proceedings, or, if no appeal is taken, when the time for filing of an appeal 3 || has run. Except as set forth below, the terms of this protective order apply through 4 || FINAL DISPOSITION of the action. The parties may stipulate that the they will be 5 || contractually bound by the terms of this agreement beyond FINAL DISPOSITION, 6 || but will have to file a separate action for enforcement of the agreement once all 7 || proceedings in this case are complete. 8 Once a case proceeds to trial, information that was designated as 9 || CONFIDENTIAL or maintained pursuant to this protective order used or introduced 10 || as an exhibit at trial becomes public and will be presumptively available to all 11 || members of the public, including the press, unless compelling reasons supported by 12 || specific factual findings to proceed otherwise are made to the trial judge in advance 13 || of the trial. See Kamakana, 447 F.3d at 1180-81 (distinguishing “good cause” 14 || showing for sealing documents produced in discovery from “compelling reasons” 15 || standard when merits-related documents are part of court record). Accordingly, for 16 || such materials, the terms of this protective order do not extend beyond the 17 || commencement of the trial. 18 19 || 5. DESIGNATING PROTECTED MATERIAL 70 5.1 Exercise of Restraint and Care in Designating Material for Protection. 21! Each Party or Non-Party that designates information or items for protection under 22 || this Order must take care to limit any such designation to specific material that 23 qualifies under the appropriate standards. The Designating Party must designate for 24 protection only those parts of material, documents, items, or oral or written > |) communications that qualify so that other portions of the material, documents, items, 76 | or communications for which protection is not warranted are not swept unjustifiably °7 || within the ambit of this Order. 28

1 Mass, indiscriminate, or routinized designations are prohibited. Designations 2 || that are shown to be clearly unjustified or that have been made for an improper 3 || purpose (e.g., to unnecessarily encumber the case development process or to impose 4 || unnecessary expenses and burdens on other parties) may expose the Designating 5 || Party to sanctions. 6 If it comes to a Designating Party’s attention that information or items that it 7 || designated for protection do not qualify for protection, that Designating Party must g || promptly notify all other Parties that it is withdrawing the inapplicable designation. 9 5.2 Manner and Timing of Designations. Except as otherwise provided in 10 || this Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise 11 || strpulated or ordered, Disclosure or Discovery Material that qualifies for protection 12 || under this Order must be clearly so designated before the material is disclosed or 13. || produced. 14 Designation in conformity with this Order requires: 15 (a) for information in documentary form (e.g., paper or electronic 16 || documents, but excluding transcripts of depositions or other pretrial or tral 17 || proceedings), that the Producing Party affix at a minimum, the legend 18 || “CONFIDENTIAL” (hereinafter “CONFIDENTIAL legend”), to each page that 19 || contains protected material. If only a portion or portions of the material on a page 20 || qualifies for protection, the Producing Party also must clearly identify the protected 21 || portion(s) (e.g., by making appropriate markings in the margins). 22 23 A Party or Non-Party that makes original documents available for inspection 24 || need not designate them for protection until after the inspecting Party has indicated 25 || which documents it would like copied and produced. During the inspection and 26 || before the designation, all of the material made available for inspection shall be 27 || deemed “CONFIDENTIAL.” After the inspecting Party has identified the 28

1 || documents it wants copied and produced, the Producing Party must determine which 2 || documents, or portions thereof, qualify for protection under this Order. Then, before 3 || producing the specified documents, the Producing Party must affix the 4 || “CONFIDENTIAL legend” to each page that contains Protected Material. If only a 5 || portion or portions of the material on a page qualifies for protection, the Producing 6 || Party also must clearly identify the protected portion(s) (e.g., by making appropriate 7 || markings in the margins). 8 (b) for testimony given in depositions that the Designating Party identify 9 ||the Disclosure or Discovery Material on the record, before the close of the deposition 10 |\all protected testimony. 1] (c) for information produced in some form other than documentary and for 12 ||any other tangible items, that the Producing Party affix in a prominent place on the 13. ||exterior of the container or containers in which the information is stored the legend 14 ||“CONFIDENTIAL.” If only a portion or portions of the information warrants 15 ||protection, the Producing Party, to the extent practicable, shall identify the protected 16 ||portion(s). 17 5.3. Inadvertent Failures to Designate. If timely corrected, an inadvertent 18 || failure to designate qualified information or items does not, standing alone, waive 19 || the Designating Party’s right to secure protection under this Order for such material. 20 || Upon timely correction of a designation, the Receiving Party must make reasonable 21 || efforts to assure that the material is treated in accordance with the provisions of this 22 || Order. 23 24 || 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS 25 6.1 Timing of Challenges. Any Party or Non-Party may challenge a 26 || designation of confidentiality at any time that is consistent with the Court’s 27 || Scheduling Order. 28

1 6.2 Meet and Confer. The Challenging Party shall initiate the dispute 2 || resolution process under Local Rule 37.1 et seq. 3 6.3. The burden of persuasion in any such challenge proceeding shall be on 4 || the Designating Party. Frivolous challenges, and those made for an improper purpose 5 || (e.g., to harass or impose unnecessary expenses and burdens on other parties) may 6 || expose the Challenging Party to sanctions. Unless the Designating Party has waived 7 || or withdrawn the confidentiality designation, all parties shall continue to afford the g || material in question the level of protection to which it is entitled under the Producing 9 || Party’s designation until the Court rules on the challenge. 10 11 || 7. ACCESS TO AND USE OF PROTECTED MATERIAL 12 7.1. Basic Principles. A Receiving Party may use Protected Material that is 13 || disclosed or produced by another Party or by a Non-Party in connection with this 14 || Action only for prosecuting, defending, or attempting to settle this Action. Such 15 || Protected Material may be disclosed only to the categories of persons and under the 16 || conditions described in this Order. When the Action has been terminated, a 17 || Receiving Party must comply with the provisions of section 13 below (FINAL 18 || DISPOSITION). 19 Protected Material must be stored and maintained by a Receiving Party at a 20 || location and in a secure manner that ensures that access is limited to the persons 21 || authorized under this Order. 22 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless 23 || otherwise ordered by the court or permitted in writing by the Designating Party, a 24 || Receiving Party may disclose any information or item designated “CONFIDENTIAL” only to: 26 (a) the Receiving Party’s Outside Counsel of Record in this Action, as well 27 || as employees of said Outside Counsel of Record to whom it is reasonably necessary 28

1 || to disclose the information for this Action; 2 (b) the officers, directors, and employees (including House Counsel) of the 3 || Receiving Party to whom disclosure is reasonably necessary for this Action; 4 (c) Experts (as defined in this Order) of the Receiving Party to whom 5 || disclosure is reasonably necessary for this Action and who have signed the 6 || “Acknowledgment and Agreement to Be Bound” (Exhibit A): 7 (d) the court and its personnel; 8 (e) court reporters and their staff; 9 (f) professional jury or trial consultants, mock jurors, and Professional 10 || Vendors to whom disclosure is reasonably necessary for this Action and who have 11 || signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 12 (g) the author or recipient of a document containing the information or a 13 || custodian or other person who otherwise possessed or knew the information; 14 (h) during their depositions, witnesses, and attorneys for witnesses, in the 15 || Action to whom disclosure is reasonably necessary provided: (1) the deposing party 16 || requests that the witness sign the form attached as Exhibit 1 hereto; and (2) they will 17 || not be permitted to keep any confidential information unless they sign the 18 || “Acknowledgment and Agreement to Be Bound” (Exhibit A), unless otherwise 19 || agreed by the Designating Party or ordered by the court. Pages of transcribed 20 || deposition testimony or exhibits to depositions that reveal Protected Material may 21 || be separately bound by the court reporter and may not be disclosed to anyone except 22 || as permitted under this Stipulated Protective Order: and 23 (i) any mediator or settlement officer, and their supporting personnel, 24 || mutually agreed upon by any of the parties engaged in settlement discussions. 25 || 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED 26 || INOTHER LITIGATION 27 If a Party is served with a subpoena or a court order issued in other litigation 28 10

1 || that compels disclosure of any information or items designated in this Action as 2 || “CONFIDENTIAL,” that Party must: 3 (a) promptly notify in writing the Designating Party. Such notification shall 4 || include a copy of the subpoena or court order; 5 (b) promptly notify in writing the party who caused the subpoena or order 6 || to issue in the other litigation that some or all of the material covered by the subpoena 7 || or order is subject to this Protective Order. Such notification shall include a copy of 8 || this Stipulated Protective Order: and 9 (c) cooperate with respect to all reasonable procedures sought to be pursued 10 || by the Designating Party whose Protected Material may be affected. 1] If the Designating Party timely seeks a protective order, the Party served 12 || with the subpoena or court order shall not produce any information designated in this 13 || action as “CONFIDENTIAL” before a determination by the court from which the 14 || subpoena or order issued, unless the Party has obtained the Designating Party’s 15 || permission. The Designating Party shall bear the burden and expense of seeking 16 || protection in that court of its confidential material and nothing in these provisions 17 || should be construed as authorizing or encouraging a Receiving Party in this Action 18 || to disobey a lawful directive from another court. 19 20 19. A _NON-PARTY’S PROTECTED MATERIAL SOUGHT 21 || TO _BE PRODUCED IN THIS LITIGATION 2 (a) The terms of this Order are applicable to information produced by a 2 Non-Party in this Action and designated as “CONFIDENTIAL.” Such information 2 produced by Non-Parties in connection with this litigation is protected by the remedies and relief provided by this Order. Nothing in these provisions should be 76 construed as prohibiting a Non-Party from seeking additional protections. 27 (b) In the event that a Party is required, by a valid discovery request, to 28 11

1 || produce a Non-Party’s confidential information in its possession, and the Party is 2 || subject to an agreement with the Non-Party not to produce the Non-Party’s 3 || confidential information, then the Party shall: 4 (1) promptly notify in writing the Requesting Party and the Non-Party 5 || that some or all of the information requested is subject to a confidentiality agreement 6 || with a Non-Party: 7 (2) promptly provide the Non-Party with a copy of the Stipulated 8 || Protective Order in this Action, the relevant discovery request(s), and a reasonably 9 || specific description of the information requested; and 10 (3) make the information requested available for inspection by the 11 || Non-Party, if requested. 12 (c) If the Non-Party fails to seek a protective order from this court within 13 || 14 days of receiving the notice and accompanying information, the Receiving Party 14 || may produce the Non-Party’s confidential information responsive to the discovery 15 || request. If the Non-Party timely seeks a protective order, the Receiving Party shall 16 || not produce any information in its possession or control that is subject to the 17 || confidentiality agreement with the Non-Party before a determination by the court. 18 || Absent a court order to the contrary, the Non-Party shall bear the burden and expense 19 || of seeking protection in this court of its Protected Material. 20 21 | 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL 2 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed 2 Protected Material to any person or in any circumstance not authorized under this 2 Stipulated Protective Order, the Receiving Party must immediately (a) notify in writing the Designating Party of the unauthorized disclosures, (b) use its best efforts 76 to retrieve all unauthorized copies of the Protected Material, (c) inform the person or 27 persons to whom unauthorized disclosures were made of all the terms of this Order, 28 12

1 || and (d) request such person or persons to execute the “Acknowledgment and 2 || Agreement to Be Bound” that is attached hereto as Exhibit A. 3 4 || 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE 5 || PROTECTED MATERIAL 6 When a Producing Party gives notice to Receiving Parties that certain inadvertently produced material is subject to a claim of privilege or other protection, 8 || the obligations of the Receiving Parties are those set forth in Federal Rule of Civil ? || Procedure 26(b)(5)(B). This provision is not intended to modify whatever procedure 10 may be established in an e-discovery order that provides for production without prior i privilege review. Pursuant to Federal Rule of Evidence 502(d) and (e), insofar as the 12 parties reach an agreement on the effect of disclosure of a communication or || information covered by the attorney-client privilege or work product protection, the parties may incorporate their agreement in the stipulated protective order submitted || to the court. 16 '7 | 12. MISCELLANEOUS 12.1 Right to Further Relief. Nothing in this Order abridges the nght of any person to seek its modification by the Court in the future. ° 12.2 Right to Assert Other Objections. By stipulating to the entry of this Protective Order no Party waives any mght it otherwise would have to object to disclosing or producing any information or item on any ground not addressed in this Stipulated Protective Order. Similarly, no Party waives any right to object on any ground to use in evidence of any of the material covered by this Protective Order. 12.3 Filing Protected Material. A Party that seeks to file under seal any °° Protected Material must comply with Civil Local Rule 79-5. Protected Material may only be filed under seal pursuant to a court order authorizing the sealing of the 13

1 || specific Protected Material at issue. If a Party's request to file Protected Material 2 || under seal is denied by the court, then the Receiving Party may file the information 3 || in the public record unless otherwise instructed by the court. 4 5 || 13. FINAL DISPOSITION 6 After the final disposition of this Action, as defined in paragraph 4, within 60 7 || days of a written request by the Designating Party, each Receiving Party must return 8 || all Protected Material to the Producing Party or destroy such material. As used in 9 || this subdivision, “all Protected Material” includes all copies, abstracts, compilations, 10 || summaries, and any other format reproducing or capturing any of the Protected 11 || Material. Whether the Protected Material is returned or destroyed, the Receiving 12 || Party must submit a written certification to the Producing Party (and, if not the same 13 || person or entity, to the Designating Party) by the 60 day deadline that (1) identifies 14 || (by category, where appropriate) all the Protected Material that was returned or 15 || destroyed and (2) affirms that the Receiving Party has not retained any copies, 16 || abstracts, compilations, summaries or any other format reproducing or capturing any 17 || of the Protected Material. Notwithstanding this provision, Counsel are entitled to 18 || retain an archival copy of all pleadings, motion papers, trial, deposition, and hearing 19 || transcripts, legal memoranda, correspondence, deposition and trial exhibits, expert 20 || reports, attorney work product, and consultant and expert work product, even if such 21 || materials contain Protected Material. Any such archival copies that contain or 22 || constitute Protected Material remain subject to this Protective Order as set forth in 23 || Section 4 (DURATION). 24 25 || 14. Any violation of this Order may be punished by any and all appropriate 26 || measures including, without limitation, contempt proceedings and/or monetary 27 || sanctions. 28 14

1 2 || ITIS SO STIPULATED, THROUGH COUNSEL OF RECORD. 3 4 || DATED: June 22, 2023 5 6 /s/Summer E. Benson 7 Maurice D. Pessah, Esq. Summer E. Benson, Esq. 8 || PESSAH LAW GROUP, PC 9 || Attorneys for Plaintiff 10 | DATED: June 22, 2023 11 /s/Shardé T. Skahan Ryan McCoy 13 |) Shardé T. Skahan || Malak Cherkaoui Jaouad Attorneys for Defendant 15 16 FOR GOOD CAUSE SHOWN, IT IS SO ORDERED. 18 19 DATED: June 23, 2023

20 Piaticcta Denahi 21 Patricia Donahue 22 || United States Magistrate Judge 23 24 25 26 27 28 15

1 EXHIBIT A 9 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND ; I, [ print or type full name], of 4 [print or type full address], declare under penalty of perjury that I have read in its entirety and understand the Stipulated Protective Order that © || was issued by the United States District Court for the Central District of California on [date] in the case of Katherine Lewis v. ADP Technology Services, Inc. et al. 8 (Case No. 2:23—cv—02583- SPG-PD). I agree to comply with and to be bound by all the terms of this Stipulated Protective Order and I understand and acknowledge 10 |) that failure to so comply could expose me to sanctions and punishment in the nature i of contempt. I solemnly promise that I will not disclose in any manner any 12 information or item that is subject to this Stipulated Protective Order to any person 13 or entity except in strict compliance with the provisions of this Order. '4 || 1 further agree to submit to the jurisdiction of the United States District Court for || the Central District of California for the purpose of enforcing the terms of this 16 Stipulated Protective Order, even if such enforcement proceedings occur after '7 || termination of this action. I hereby appoint [print or 18 type full name] of [print or type full address and telephone number] as 19 my California agent for service of process in connection with this action or any 20 proceedings related to enforcement of this Stipulated Protective Order. 21 22 Date: 23 City and State where sworn and signed: Printed name: 26 27 Signature: 28 16