Veribi, LLC v. Compass Mining Inc

Opinion

1 Alan E. Engle (SBN 224779) GUNDZIK GUNDZIK HEEGER LLP alan.engle@meenlegal.com Aaron C. Gundzik (State Bar No. 132137) 2 MEADOR & ENGLE Aaron.gundzik@gghllp.com 3 1115 Seal Way 14011 Ventura Blvd, Suite 206E Seal Beach, CA 90740 Sherman Oaks, CA 91423 4 Telephone: (310) 428-6985 Telephone: 818.290.7461 Facsimile: (714) 386-5368 Facsimile: 818.918.2316 5 Attorneys for Plaintiff, Veribi, LLC ARMSTRONG TEASDALE LLP 6 Michael A. Gehret (State Bar No. 247869) 7 Peter H. Donaldson (pro hac vice) Telephone: 801.401.1600 8 Facsimile: 314.621.5065 9 Attorneys for Defendant, Compass 10 Mining, Inc.

11 UNITED STATES DISTRICT COURT 12 13 CENTRAL DISTRICT OF CALIFORNIA 14 VERIBI, LLC, a Nevada limited Case No.: 2:22-CV-04537-MEMF-JPR 15 liability company, Hon. Maame Ewusi-Mensah Frimpong 16 Plaintiff, Magistrate: Hon. Jean P. Rosenbluth 17 v. STIPULATED PROTECTIVE 18 COMPASS MINING, INC., a ORDER GOVERNING Delaware corporation, CONFIDENTIAL INFORMATION 19 Defendant. 20 21 1. INTRODUCTION 22 1.1 PURPOSES AND LIMITATIONS 23 Discovery in this action may involve production of confidential, proprietary, 24 or private information for which special protection from public disclosure and from 25 use for any purpose other than prosecuting this litigation may be warranted. 26 Accordingly, the Parties hereby stipulate to and petition the Court to enter the 27 1 || does not confer blanket protections on all disclosures or responses to discovery and 2 || that the protection it affords from public disclosure and use extends only to the 3 || limited information or items that are entitled to confidential treatment under the 4 || applicable legal principles. The Parties further acknowledge, as set forth in Section 5 || 12.3 below, that this Order does not entitle them to file Confidential Information 6 || under seal; Civil Local Rule 79-5 sets forth the procedures that must be followed 7 || and the standards that will be applied when a Party seeks permission from the Court 8 || to file material under seal. 9 1.2 GOOD CAUSE STATEMENT 10 On September 28, 2023, the Court held a hearing after briefing and found that 11 || good cause exists for entry of a Stipulated Protective Order in this matter. The 12 || parties therefore submit this Proposed Joint Protective Order pursuant to the Court’s 13 || September 23, 2023 Order. 14 This dispute is between Plaintiff Veribi, LLC (“Veribi’”’) and Defendant 15 || Compass Mining, Inc. (“Compass”). The dispute involves Compass’s termination 16 || of its dealings with a foreign hosting services provider BitRiver AG (“BitRiver’”) 17 || who has facilities in Russia, following the addition of BitRiver to the U.S. 18 || Department of Treasury Office of Foreign Asset Control’s Specially Designated 19 || Nationals list. 20 The dispute in this case and related discovery may implicate Compass’s 21 || commercially sensitive information, as well as its customers’ confidential 22 || information, possibly including, Compass contends, the following: 23 e The specific addresses of Compass’s hosting locations; 24 e The specific terms of Compass’s hosting agreements with hosting centers, 25 including contractual hosting rates; 26 e Compass customers’ personally identifying information, including names, 27 addresses, and financial information; Case No. 2:22-CV-04537-MEMF-JPR ° [PROPOSED] STIP. PROTECTIVE ORDER

1 e Serial numbers and MAC addresses of Compass customers’ cryptocurrency 2 miners; 3 e Financial records and information, including bank account numbers for both 4 Compass and its customers; and 5 e Compass’s private, strategic business discussions and negotiation tactics with 6 hosting providers. 7 (a) Potential harm should certain relevant materials be disclosed publicly 8 While Compass does not believe all of the information listed above is 9 || relevant, discoverable, or admissible in this case, and accordingly reserves all rights, 10 || if the information listed above were to be disclosed publicly, it might impose 11 || significant, particularized harm on Compass and its customers. The risks from 12 || disclosure provide good cause for a protective order with a “CONFIDENTIAL” 13 || designation. See, e.g., DeHate v. Lowe’s Home Centers, LLC, 2020 WL 7084551, at 14 || *4(C.D. Cal. Oct. 8, 2020) (granting protective order to prevent public disclosure of 15 || surveillance videos, finding good cause because “the public could exploit that 16 || information to commit theft or other undesirable acts”); Estate of Sanchez v. County 17 || of Stanislaus, 2019 WL 1959579 (E.D. Cal. May 2, 2019) (noting discovery rules 18 || must balance the potential for abuse, including “damage to the reputation and 19 || privacy of litigants and third parties”). 20 (b) Potential harm should certain relevant materials be disclosed publicly 21 || or to the parties in this Action 22 Some of the information listed above is nonpublic and extremely 23 || commercially sensitive and might impose harm if disclosed to the public or to 24 || Veribi. In light of these risks, there is good cause for a protective order with an 25 || attorneys’ eyes only provision. See, e.g., Kaseberg v. Conaco, LLC, 2016 WL 26 || 3997600 (S.D. Cal. July 26, 2016) (attorneys’ eyes only provision appropriate to 27 || prevent disclosure of licensing fees, finding that good cause exists because Case No. 2:22-CV-04537-MEMF-JPR ° [PROPOSED] STIP. PROTECTIVE ORDER

1 disclosure would “severely impact” 2 defendants’ ability to negotiate future licenses); DeHate, 2020 WL 7084551 at *4 3 (possible damage to defendant’s competitive advantage constituted good cause to 4 prevent disclosure of policies and procedures, as well as security measures). 5 2. DEFINITIONS 6 2.1 Action: This case, Veribi, LLC v. Compass Mining, Inc., 2:22-CV- 7 04537-MEMF-JPR, pending in the United States District Court for 8 the Central District of California. 9 2.2 “AEO” Information or Items: Extremely sensitive “CONFIDENTIAL” 10 Information or Items, the disclosure of which to another Party or Nonparty would 11 create a substantial risk of serious harm that could not be avoided by less restrictive 12 means. 13 2.3 Challenging Party: a Party or Nonparty that challenges the designation 14 of information or items under this Order. 15 2.4 “CONFIDENTIAL” Information or Items: information (regardless of 16 how it is generated, stored, or maintained) or tangible things that qualify for 17 protection under Federal Rule of Civil Procedure 26(c) and as specified above in the 18 Good Cause Statement. 19 2.5 Counsel: Outside Counsel of Record and House Counsel (as well as 20 their support staff). 21 2.6 Designating Party: a Party or Nonparty that designates information or 22 items that it produces in disclosures or in responses to discovery as 23 “CONFIDENTIAL.” 24 2.7 Disclosure or Discovery Material: all items or information, regardless 25 of the medium or manner in which it is generated, stored, or maintained (including, 26 among other things, testimony, transcripts, and tangible things), that are produced or 27 generated in disclosures or responses to discovery in this matter. 1 2.8 Expert: a person with specialized knowledge or experience in a matter 2 pertinent to the litigation who has been retained by a Party or its counsel to serve as 3 an expert witness or as a consultant in this action. 4 2.9 House Counsel: attorneys who are employees of a Party to this Action. 5 House Counsel does not include Outside Counsel of Record or any other outside 6 counsel. 7 2.10 Nonparty: any natural person, partnership, corporation, association, or 8 other legal entity not named as a Party to this action. 9 2.11 Outside Counsel of Record: attorneys who are not employees of a 10 Party to this Action but are retained to represent or advise a Party and have appeared 11 in this Action on behalf of that Party or are affiliated with a law firm that has 12 appeared on behalf of that Party, including support staff. 13 2.12 Party: any Party to this Action, including all of its officers, directors, 14 employees, consultants, retained experts, and Outside Counsel of Record (and their 15 support staffs). 16 2.13 Producing Party: a Party or Nonparty that produces Disclosure or 17 Discovery Material in this Action. 18 2.14 Professional Vendors: persons or entities that provide litigation 19 support services (for example, photocopying, videotaping, translating, preparing 20 exhibits or demonstrations, and organizing, storing, or retrieving data in any form or 21 medium) and their employees and subcontractors. 22 2.15 Protected Material: any Disclosure or Discovery Material that is 23 designated as “CONFIDENTIAL” or “AEO”. 24 2.16 Receiving Party: a Party that receives Disclosure or Discovery 25 Material from a Producing Party. 26 3. SCOPE 27 1 The protections conferred by this Stipulation and Order cover not only 2 Protected Material (as defined above) but also any information copied or extracted 3 from Protected Material; all copies, excerpts, summaries, or compilations of 4 Protected Material; and any testimony, conversations, or presentations by Parties or 5 their Counsel that might reveal Protected Material. 6 Any use of Protected Material at trial will be governed by the orders of the 7 trial judge. This Order does not govern the use of Protected Material at trial. 8 4. DURATION 9 Even after final disposition of this litigation, the confidentiality obligations 10 imposed by this Order will remain in effect until a Designating Party agrees 11 otherwise in writing or a court order otherwise directs. Final disposition is the later 12 of (1) dismissal of all claims and defenses in this Action, with or without prejudice, 13 or (2) final judgment after the completion and exhaustion of all appeals, rehearings, 14 remands, trials, or reviews of this Action, including the time limits for filing any 15 motions or applications for extension of time under applicable law. 16 5. DESIGNATING PROTECTED MATERIAL 17 5.1 Each Party or Nonparty that designates information or items for 18 protection under this Order must take care to limit any such designation to specific 19 material that qualifies under the appropriate standards. The Designating Party must 20 designate for protection only those parts of material, documents, items, or oral or 21 written communications that qualify so that other portions of the material, 22 documents, items, or communications for which protection is not warranted are not 23 swept unjustifiably within the ambit of this Order. 24 Mass, indiscriminate, or routinized designations are prohibited. Designations 25 that are shown to be clearly unjustified or that have been made for an improper 26 purpose (for example, to unnecessarily encumber the case-development process or 27 1 to impose unnecessary expenses and burdens on other parties) may expose the 2 Designating Party to sanctions. 3 If it comes to a Designating Party’s attention that information or items it 4 designated for protection do not qualify for that level of protection, that Designating 5 Party must promptly notify all other Parties that it is withdrawing the inapplicable 6 designation. 7 5.2 Except as otherwise provided in this Order, Disclosure or Discovery 8 Material that qualifies for protection under this Order must be clearly so designated 9 before the material is disclosed or produced. 10 Designation in conformity with this Order requires the following: 11 (a) for information in documentary form (for example, paper or electronic 12 documents but excluding transcripts of depositions or other pretrial or trial 13 proceedings), the Producing Party must affix at a minimum the legend 14 “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL – AEO” to each page that 15 contains Protected Material. If only a portion or portions of the material on a page 16 qualify for protection, the Producing Party must clearly identify the protected 17 portion(s) (for example, by making appropriate markings in the margins). 18 A Party or Nonparty that makes original documents available for inspection 19 need not designate them for protection until after the inspecting Party has indicated 20 which documents it would like copied and produced. During the inspection and 21 before the designation, all material made available for inspection must be treated as 22 “AEO.” After the inspecting Party has identified the documents it wants copied and 23 produced, the Producing Party must determine which documents, or portions 24 thereof, qualify for protection under this Order. Then, before producing the 25 specified documents, the Producing Party must affix the “CONFIDENTIAL” or 26 “HIGHLY CONFIDENTIAL – AEO” legend to each page that contains Protected 27 Material. If only a portion or portions of the material on a page qualify for 1 protection, the Producing Party also must clearly identify the protected portion(s) 2 (for example, by making appropriate markings in the margins). 3 (b) for testimony given in depositions, the Designating Party must identify 4 the Disclosure or Discovery Material that is protected on the record, before the close 5 of the deposition. 6 (c) for information produced in some form other than documentary and for 7 any other tangible items, the Producing Party must affix in a prominent place on the 8 exterior of the container or containers in which the information is stored the legend 9 “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL – AEO.” If only a portion or 10 portions of the information warrant protection, the Producing Party, to the extent 11 practicable, must identify the protected portion(s). 12 5.3 If timely corrected, an inadvertent failure to designate qualified 13 information or items does not, standing alone, waive the Designating Party’s right to 14 secure protection under this Order for that material. On timely correction of a 15 designation, the Receiving Party must make reasonable efforts to assure that the 16 material is treated in accordance with the provisions of this Order. 17 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS UNDER THIS 18 ORDER 19 6.1 Any Party or Nonparty may challenge a designation of confidentiality 20 or AEO at any time consistent with the Court’s scheduling order. 21 6.2 The Challenging Party must initiate the dispute-resolution process (and, 22 if necessary, file a discovery motion) under Local Rule 37. 23 6.3 The burden of persuasion in any such proceeding is on the Designating 24 Party. Frivolous challenges, and those made for an improper purpose (for example, 25 to harass or impose unnecessary expenses and burdens on other parties), may expose 26 the Challenging Party to sanctions. Unless the Designating Party has waived or 27 withdrawn the confidentiality designation, all parties must continue to afford the 1 material in question the level of protection to which it is entitled under the 2 Producing Party’s designation until the Court rules on the challenge. 3 7. ACCESS TO AND USE OF PROTECTED MATERIAL 4 7.1 A Receiving Party may use Protected Material that is disclosed or 5 produced by another Party or by a Nonparty in connection with this Action only for 6 prosecuting, defending, or attempting to settle this Action. Such Protected Material 7 may be disclosed only to the categories of people and under the conditions described 8 in this Order. When the Action has been terminated, a Receiving Party must comply 9 with the provisions of Section 13 below (FINAL DISPOSITION). 10 Protected Material must be stored and maintained by a Receiving Party at a 11 location and in a manner sufficiently secure to ensure that access is limited to the 12 people authorized under this Order. 13 7.2 Unless otherwise ordered by the Court or permitted in writing by the 14 Designating Party, a Receiving Party may disclose any information or item 15 designated “CONFIDENTIAL” only to the following people: 16 (a) the Receiving Party’s Outside Counsel of Record in this Action, as 17 well as employees of that Outside Counsel of Record to whom it is reasonably 18 necessary to disclose the information for this Action; 19 (b) the officers, directors, and employees (including House Counsel) of 20 the Receiving Party to whom disclosure is reasonably necessary for this Action; 21 (c) Experts (as defined in this Order) of the Receiving Party to whom 22 disclosure is reasonably necessary for this Action and who have signed the 23 “Acknowledgment and Agreement to Be Bound” (Exhibit A); 24 (d) the Court and its personnel; 25 (e) court reporters and their staff; 26 27 1 (f) professional jury or trial consultants, mock jurors, and Professional 2 Vendors to whom disclosure is reasonably necessary for this Action and who have 3 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 4 (g) the author or recipient of a document containing the information or a 5 custodian or other person who otherwise possessed or knew the information; 6 (h) during their depositions, witnesses and attorneys for witnesses to 7 whom disclosure is reasonably necessary, provided that the deposing party requests 8 that the witness sign the form attached as Exhibit A hereto and the witnesses will 9 not be permitted to keep any confidential information unless they sign the form, 10 unless otherwise agreed by the Designating Party or ordered by the Court. Pages of 11 transcribed deposition testimony or exhibits to depositions that reveal Protected 12 Material may be separately bound by the court reporter and may not be disclosed to 13 anyone except as permitted under this Order; and 14 (i) any mediator or settlement officer, and their supporting personnel, 15 mutually agreed on by any of the Parties engaged in settlement discussions or 16 appointed by the Court. 17 7.3 Unless otherwise ordered by the Court or permitted in writing by 18 the Designating Party, a Receiving Party may disclose any information or item 19 designated “HIGHLY CONFIDENTIAL—AEO” only to the following people: 20 (a) the Court and its employees (“Court Personnel”); 21 (b) copy, data, hosting, and other providers of litigation services retained 22 by counsel for the Parties for the purposes of the Action; 23 (c) in-house and outside attorneys for the Parties, and those attorneys’ 24 respective employees; 25 (d) court reporters and videographers transcribing or filming depositions 26 or testimony involving AEO Documents; 27 1 (e) expert witnesses and consultants retained in connection with this civil 2 action, to the extent such disclosure is necessary for preparation, trial or other 3 proceedings in this civil action; 4 (f) deponents or witnesses only if the deponent or witness’s name is on 5 the AEO document in question or the Court otherwise orders. 6 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED 7 IN OTHER LITIGATION 8 If a Party is served with a subpoena or a court order issued in other litigation 9 that compels disclosure of any information or items designated in this Action as 10 “CONFIDENTIAL or “AEO,” that Party must 11 (a) promptly notify in writing the Designating Party. Such notification 12 must include a copy of the subpoena or court order unless prohibited by law; 13 (b) promptly notify in writing the party who caused the subpoena or order 14 to issue in the other litigation that some or all of the material covered by the 15 subpoena or order is subject to this Protective Order. Such notification must include 16 a copy of this Order; and 17 (c) cooperate with respect to all reasonable procedures sought to be 18 pursued by the Designating Party whose Protected Material may be affected. 19 If the Designating Party timely seeks a protective order, the Party served with 20 the subpoena or court order should not produce any information designated in this 21 action as “CONFIDENTIAL” or “AEO” before a determination on the protective- 22 order request by the relevant court unless the Party has obtained the Designating 23 Party’s permission. The Designating Party bears the burden and expense of seeking 24 protection of its Confidential Material, and nothing in these provisions should be 25 construed as authorizing or encouraging a Receiving Party in this Action to disobey 26 a lawful directive from another court. 27 1 9. A NONPARTY’S PROTECTED MATERIAL SOUGHT TO BE 2 PRODUCED IN THIS LITIGATION 3 (a) The terms of this Order are applicable to information produced by a 4 Nonparty in this Action and designated as “CONFIDENTIAL” or “AEO.” Such 5 information is protected by the remedies and relief provided by this Order. Nothing 6 in these provisions should be construed as prohibiting a Nonparty from seeking 7 additional protections. 8 (b) In the event that a Party is required by a valid discovery request to 9 produce a Nonparty’s Confidential or AEO Information in its possession and the 10 Party is subject to an agreement with the Nonparty not to produce the Nonparty’s 11 Confidential of AEO Information, then the Party must 12 (1) promptly notify in writing the Requesting Party and the Nonparty 13 that some or all of the information requested is subject to a confidentiality 14 agreement with a Nonparty; 15 (2) promptly provide the Nonparty with a copy of this Order, the 16 relevant discovery request(s), and a reasonably specific description of the 17 information requested; and 18 (3) make the information requested available for inspection by the 19 Nonparty, if requested. 20 (c) If the Nonparty fails to seek a protective order within 21 days of 21 receiving the notice and accompanying information, the Receiving Party may 22 produce the Nonparty’s Confidential or AEO Information responsive to the 23 discovery request. If the Nonparty timely seeks a protective order, the Receiving 24 Party must not produce any information in its possession or control that is subject to 25 the confidentiality agreement with the Nonparty before a ruling on the protective- 26 order request. Absent a court order to the contrary, the Nonparty must bear the 27 burden and expense of seeking protection of its Protected Material. 1 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL 2 If a Receiving Party learns that by inadvertence or otherwise, it has disclosed 3 Protected Material to any person or in any circumstance not authorized under this 4 Order, the Receiving Party must immediately notify the Designating Party in writing 5 of the unauthorized disclosures, use its best efforts to retrieve all unauthorized 6 copies of the Protected Material, inform the person or people to whom unauthorized 7 disclosures were made of the terms of this Order, and ask that person or people to 8 execute the “Acknowledgment and Agreement to Be Bound” that is attached hereto 9 as Exhibit A. 10 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE 11 PROTECTED MATERIAL When a Producing Party gives notice to Receiving Parties that certain 12 inadvertently produced material is subject to a claim of privilege or other protection, 13 the obligations of the Receiving Parties are those set forth in Federal Rule of Civil 14 Procedure 26(b)(5)(B). 15 12. MISCELLANEOUS 16 12.1 Nothing in this Order abridges the right of any person to seek its 17 modification by the Court. 18 12.2 By stipulating to the entry of this Order, no Party waives any right it 19 otherwise would have to object to disclosing or producing any information or item 20 on any ground not addressed in this Order. Similarly, no Party waives any right to 21 object on any ground to use in evidence of any of the material covered by this 22 Order. 23 12.3 A Party that seeks to file under seal any Protected Material must 24 comply with Civil Local Rule 79-5. Protected Material may be filed under seal only 25 pursuant to a court order authorizing the sealing of the specific Protected Material at 26 issue. If a Party's request to file Protected Material under seal is denied, then the 27 1 Receiving Party may file the information in the public record unless otherwise 2 instructed by the Court. 3 13. FINAL DISPOSITION 4 After the final disposition of this Action, as defined in paragraph 4, within 60 5 days of a written request by the Designating Party, each Receiving Party must return 6 all Protected Material to the Producing Party or destroy such material. As used in 7 this subdivision, “all Protected Material” includes all copies, abstracts, compilations, 8 summaries, and any other format reproducing or capturing any of the Protected 9 Material. Whether the Protected Material is returned or destroyed, the Receiving 10 Party must submit a written certification to the Producing Party (and, if not the same 11 person or entity, to the Designating Party) by the 60-day deadline that identifies (by 12 category, when appropriate) all the Protected Material that was returned or 13 destroyed and affirms that the Receiving Party has not retained any copies, abstracts, 14 compilations, summaries, or any other format reproducing or capturing any of the 15 Protected Material. Notwithstanding this provision, Counsel are entitled to retain an 16 archival copy of all pleadings; motion papers; trial, deposition, and hearing 17 transcripts; legal memoranda; correspondence; deposition and trial exhibits; expert 18 reports; attorney work product; and consultant and expert work product even if such 19 materials contain Protected Material. Any such archival copies that contain or 20 constitute Protected Material remain subject to this Order as set forth in Section 4 21 (DURATION). 22 23 24 25 26 27 1 || 14. SANCTIONS 2 Any willful violation of this Order may be punished by civil or criminal 3 || contempt, financial or evidentiary sanctions, reference to disciplinary authorities, or 4 || other appropriate action at the discretion of the Court. 5 6 || ITIS SO STIPULATED, THROUGH COUNSEL OF RECORD. 7 8 || DATED: October 13, 2023 MEADOR & ENGLE 9 /s/ Alan Engle 10 Alan E. Engle Attorneys for Plaintiff Veribi, LLC

12 13 || DATED: October 13, 2023 ARMSTRONG TEASDALE LLP 14 /s/ Peter Donaldson I5 Peter H. Donaldson Michael A. Gehret 16 Attorneys for Defendant 7 Compass Mining, Inc.

18 || DATED: 10/17/2023 19 l i Uf, 20 91 || JEAN P. ROSENBLUTH U.S. MAGISTRATE JUDGE 22 23 24 25 26 27 28 15 Case No. 2:22-CV-04537-MEMF-JPR [PROPOSED] STIP. PROTECTIVE ORDER

1 EXHIBIT A 2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND 3 I, _____________________________ [full name], of _________________ 4 ________________________________ [full address], declare under penalty of 5 perjury that I have read in its entirety and understand the Stipulated Protective Order 6 that was issued by the U.S. District Court for the Central District of California on 7 October __, 2023 in the case of Veribi, LLC v. Compass Mining, Inc., No. 2:22-CV- 8 04537-MEMF-JPR. I agree to comply with and to be bound by all terms of this 9 Stipulated Protective Order, and I understand and acknowledge that failure to so 10 comply could expose me to sanctions and punishment, including contempt. I 11 solemnly promise that I will not disclose in any manner any information or item that 12 is subject to this Stipulated Protective Order to any person or entity except in strict 13 compliance with the provisions of this Order. 14 I further agree to submit to the jurisdiction of the U.S. District Court for the 15 Central District of California for the purpose of enforcing the terms of this 16 Stipulated Protective Order, even if such enforcement proceedings occur after 17 termination of this action. I hereby appoint __________________________ [full 18 name] of _______________________________________ [full address and 19 telephone number] as my California agent for service of process in connection with 20 this action or any proceedings related to enforcement of this Stipulated Protective 21 Order. 22 Date: ______________________________________ 23 City and State where signed: ________________________________ 24 Printed name: _______________________________ 25 26 Signature: __________________________________ 27