Eric Podwall v. William Smokey Robinson, Jr.

Filing 60

PROTECTIVE ORDER by Magistrate Judge Alicia G. Rosenberg re Minutes of Telephonic Discovery Conference & Order Re Entry of Protective Order and Defendant's Renewed Motion to Quash Certain Subpoenas 59 . (see order for details) (hr)

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1 2 3 4 5 6 7 8 9 10 11 12 13 Rhonda H. Wills (SBN 323435) rwills@rwillslawfirm.com WILLS LAW FIRM, PLLC 1776 Yorktown, Suite 570 Houston, Texas 77056 Telephone: (713) 528-4455 Facsimile: (713) 528-2047 George P. Moschopoulos (SBN 249905) georgem@logmapc.com THE LAW OFFICE OF GEORGE MOSCHOPOULOS, APC 34197 Pacific Coast Hwy, Suite 100 Dana Point, California 92629 Telephone: (714) 904-1669 Facsimile: (949) 272-0428 Attorneys for Defendant WILLIAM “SMOKEY” ROBINSON, JR. 14 UNITED STATES DISTRICT COURT 15 CENTRAL DISTRICT OF CALIFORNIA 16 17 ERIC PODWALL, an individual, 18 Plaintiff, 19 20 21 v. Case No. 2:16-CV-06088-ODW-AGR HON. OTIS D. WRIGHT II PROTECTIVE ORDER1 WILLIAM “SMOKEY” ROBINSON, JR., an individual. 22 Defendant. 23 24 25 26 27 28 1. A. PURPOSES AND LIMITATIONS As a party (or parties) claims that discovery in this action is likely to involve production of confidential, proprietary, or private information for which special protection from public disclosure and from use for any purpose other than prosecuting this litigation may be warranted, this Court enters the following 1 2 Protective Order. This Order does not confer blanket protections on all disclosures 3 or responses to discovery. The protection it affords from public disclosure and use 4 extends only to the limited information or items that are entitled to confidential 5 treatment under the applicable legal principles. Further, as set forth in Section 12.3, 6 below, this Protective Order does not entitle the parties to file confidential 7 information under seal. Rather, when the parties seek permission from the court to 8 file material under seal, the parties must comply with Civil Local Rule 79-5 and 9 with any pertinent orders of the assigned District Judge and Magistrate Judge. 10 B. GOOD CAUSE STATEMENT 11 In light of the nature of the claims and allegations in this case and a party or 12 parties’ representations that discovery in this case will involve the production of 13 confidential records, and in order to expedite the flow of information, to facilitate 14 the prompt resolution of disputes over confidentiality of discovery materials, to 15 adequately protect information the parties are entitled to keep confidential, to ensure 16 that the parties are permitted reasonable necessary uses of such material in 17 connection with this action, to address their handling of such material at the end of 18 the litigation, and to serve the ends of justice, a protective order for such information 19 is justified in this matter. The parties shall not designate any information/documents 20 as confidential without a good faith belief that such information/documents have 21 been maintained in a confidential, non-public manner, and that there is good cause 22 or a compelling reason, as appropriate, why it should not be part of the public record 23 of this case. 24 2. DEFINITIONS 25 2.1Action: The instant action: Eric Podwall v. William “Smokey” 26 Robinson, Jr., Case No. 2:16-CV-06088-ODW-AGR, United States District Court for 27 the Central District of California. 28 2.2Challenging Party: a Party or Non-Party that challenges the designation of 2 1 2 information or items under this Order. 2.3 3 “CONFIDENTIAL” Information or Items: information (regardless of 4 how it is generated, stored or maintained) or tangible things that qualify for 5 protection under Federal Rule of Civil Procedure 26(c), and as specified above in 6 the Good Cause Statement. 7 2.4 “HIGHLY CONFIDENTIAL -- ATTORNEYS’ EYES ONLY” 8 Information or Items: extremely sensitive “CONFIDENTIAL” Information or 9 Items, the disclosure of which to another Party or Non-Party would create a 10 11 12 13 substantial risk of serious harm that could not be avoided by less restrictive means. 2.5 Counsel: Outside Counsel of Record and House Counsel (as well as their support staff). 2.6 Designating Party: a Party or Non-Party that designates information or 14 items that it produces in disclosures or in responses to discovery as 15 “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL -- ATTORNEYS’ EYES 16 ONLY.” 17 2.7 Disclosure or Discovery Material: all items or information, regardless 18 of the medium or manner in which it is generated, stored, or maintained (including, 19 among other things, testimony, transcripts, and tangible things), that are produced or 20 generated in disclosures or responses to discovery in this matter. 21 2.8 Expert: a person with specialized knowledge or experience in a matter 22 pertinent to the litigation who has been retained by a Party or its counsel to serve as 23 an expert witness or as a consultant in this Action. 24 2.9 House Counsel: attorneys who are employees of a party to this Action. 25 House Counsel does not include Outside Counsel of Record or any other outside 26 counsel. 27 28 2.10 Non-Party: any natural person, partnership, corporation, association, or other legal entity not named as a Party to this action. 3 1 2.11 Outside Counsel of Record: attorneys who are not employees of a 2 3 party to this Action but are retained to represent or advise a party to this Action and 4 have appeared in this Action on behalf of that party or are affiliated with a law firm 5 which has appeared on behalf of that party, and includes support staff. 2.12 Party: any party to this Action, including all of its officers, directors, 6 7 employees, consultants, retained experts, and Outside Counsel of Record (and their 8 support staffs). 2.13 Producing Party: a Party or Non-Party that produces Disclosure or 9 10 Discovery Material in this Action. 11 2.14 Professional Vendors: persons or entities that provide litigation 12 support services (e.g., photocopying, videotaping, translating, preparing exhibits or 13 demonstrations, and organizing, storing, or retrieving data in any form or medium) 14 and their employees and subcontractors. 2.15 Protected Material: any Disclosure or Discovery Material that is 15 16 designated as “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL -- 17 ATTORNEYS’ EYES ONLY.” 2.16 Receiving Party: a Party that receives Disclosure or Discovery 18 19 Material from a Producing Party. 20 3. SCOPE 21 The protections conferred by this Order cover not only Protected Material (as 22 defined above), but also (1) any information copied or extracted from Protected 23 Material; (2) all copies, excerpts, summaries, or compilations of Protected Material; 24 and (3) any deposition testimony, conversations, or presentations by Parties or their 25 Counsel that might reveal Protected Material, other than during a court hearing or at 26 trial. 27 28 Any use of Protected Material during a court hearing or at trial shall be governed by the orders of the presiding judge. This Order does not govern the use 4 1 2 3 4 of Protected Material during a court hearing or at trial. 4. DURATION Even after final disposition of this litigation, the confidentiality obligations 5 imposed by this Order shall remain in effect until a Designating Party agrees 6 otherwise in writing or a court order otherwise directs. Final disposition shall be 7 deemed to be the later of (1) dismissal of all claims and defenses in this Action, with 8 or without prejudice; and (2) final judgment herein after the completion and 9 exhaustion of all appeals, rehearings, remands, trials, or reviews of this Action, 10 including the time limits for filing any motions or applications for extension of time 11 pursuant to applicable law. 12 5. DESIGNATING PROTECTED MATERIAL 13 5.1 14 Each Party or Non-Party that designates information or items for protection Exercise of Restraint and Care in Designating Material for Protection. 15 under this Order must take care to limit any such designation to specific material 16 that qualifies under the appropriate standards. The Designating Party must designate 17 for protection only those parts of material, documents, items, or oral or written 18 communications that qualify so that other portions of the material, documents, 19 items, or communications for which protection is not warranted are not swept 20 unjustifiably within the ambit of this Order. 21 Mass, indiscriminate, or routinized designations are prohibited. Designations 22 that are shown to be clearly unjustified or that have been made for an improper 23 purpose (e.g., to unnecessarily encumber the case development process or to impose 24 unnecessary expenses and burdens on other parties) may expose the Designating 25 Party to sanctions. 26 If it comes to a Designating Party’s attention that information or items that it 27 designated for protection do not qualify for protection, that Designating Party must 28 promptly notify all other Parties that it is withdrawing the inapplicable designation. 5 1 2 5.2 Manner and Timing of Designations. Except as otherwise provided in 3 this Order (see, e.g., second paragraph of Section 5.2(a) below), or as otherwise 4 stipulated or ordered, Disclosure or Discovery Material that qualifies for protection 5 under this Order must be clearly so designated before the material is disclosed or 6 produced. 7 8 9 Designation in conformity with this Order requires: (a) for information in documentary form (e.g., paper or electronic documents, but excluding transcripts of depositions), that the Producing Party affix 10 at a minimum, the legend “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL -- 11 ATTORNEYS’ EYES ONLY” to each page that contains protected material. If 12 only a portion or portions of the material on a page qualifies for protection, the 13 Producing Party also must clearly identify the protected portion(s) (e.g., by making 14 appropriate markings in the margins). 15 A Party or Non-Party that makes original documents available for inspection 16 need not designate them for protection until after the inspecting Party has indicated 17 which documents it would like copied and produced. During the inspection and 18 before the designation, all of the material made available for inspection shall be 19 deemed “CONFIDENTIAL.” After the inspecting Party has identified the 20 documents it wants copied and produced, the Producing Party must determine which 21 documents, or portions thereof, qualify for protection under this Order. Then, 22 before producing the specified documents, the Producing Party must affix the 23 “CONFIDENTIAL”, or “HIGHLY CONFIDENTIAL -- ATTORNEYS’ EYES 24 ONLY” legend to each page that contains Protected Material. If only a portion or 25 portions of the material on a page qualifies for protection, the Producing Party also 26 must clearly identify the protected portion(s) (e.g., by making appropriate markings 27 in the margins). 28 (b) for testimony given in depositions that the Designating Party identifies 6 1 2 on the record, before the close of the deposition as protected testimony. (c) for information produced in some form other than documentary and 3 4 for any other tangible items, that the Producing Party affix in a prominent place on 5 the exterior of the container or containers in which the information is stored the 6 legend “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL -- ATTORNEYS’ 7 EYES ONLY.” If only a portion or portions of the information warrants protection, 8 the Producing Party, to the extent practicable, shall identify the protected portion(s). 9 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent 10 failure to designate qualified information or items does not, standing alone, waive 11 the Designating Party’s right to secure protection under this Order for such material. 12 Upon timely correction of a designation, the Receiving Party must make reasonable 13 efforts to assure that the material is treated in accordance with the provisions of this 14 Order. 15 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS 16 6.1 Timing of Challenges. Any Party or Non-Party may challenge a 17 designation of confidentiality at any time that is consistent with the Court’s 18 Scheduling Order. 19 20 21 6.2 Meet and Confer. The Challenging Party shall initiate the dispute resolution process under Local Rule 37-1 et seq. 6.3The burden of persuasion in any such challenge proceeding shall be on the 22 Designating Party. Frivolous challenges, and those made for an improper purpose 23 (e.g., to harass or impose unnecessary expenses and burdens on other parties) may 24 expose the Challenging Party to sanctions. Unless the Designating Party has waived 25 or withdrawn the confidentiality designation, all parties shall continue to afford the 26 material in question the level of protection to which it is entitled under the 27 Producing Party’s designation until the Court rules on the challenge. 28 7. ACCESS TO AND USE OF PROTECTED MATERIAL 7 1 2 7.1 Basic Principles. A Receiving Party may use Protected Material that is 3 disclosed or produced by another Party or by a Non-Party in connection with this 4 Action only for prosecuting, defending, or attempting to settle this Action. Such 5 Protected Material may be disclosed only to the categories of persons and under the 6 conditions described in this Order. When the Action has been terminated, a 7 Receiving Party must comply with the provisions of Section 13 below. 8 9 10 11 Protected Material must be stored and maintained by a Receiving Party at a location and in a secure manner that ensures that access is limited to the persons authorized under this Order. 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless 12 otherwise ordered by the court or permitted in writing by the Designating Party, a 13 Receiving Party may disclose any information or item designated 14 “CONFIDENTIAL” only to: 15 (a) the Receiving Party’s Outside Counsel of Record in this Action, as 16 well as employees of said Outside Counsel of Record to whom it is reasonably 17 necessary to disclose the information for this Action; 18 (b) the Receiving Party; 19 (c) Experts (as defined in this Order) of the Receiving Party to whom 20 disclosure is reasonably necessary for this Action and who have signed the 21 “Acknowledgment and Agreement to Be Bound” (Exhibit A); 22 (d) the court and its personnel; 23 (e) private court reporters and their staff to whom disclosure is reasonably 24 necessary for this Action and who have signed the “Acknowledgment and 25 Agreement to Be Bound” (Exhibit A); 26 (f) professional jury or trial consultants, mock jurors, and Professional 27 Vendors to whom disclosure is reasonably necessary for this Action and who have 28 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 8 1 (g) the author or recipient of a document containing the information or a 2 3 custodian or other person who otherwise possessed or knew the information; (h) during their depositions, witnesses, and attorneys for witnesses, in the 4 5 Action to whom disclosure is reasonably necessary provided: (1) the deposing party 6 requests that the witness sign the “Acknowledgment and Agreement to Be Bound” 7 (Exhibit A); and (2) they will not be permitted to keep any confidential information 8 unless they sign the “Acknowledgment and Agreement to Be Bound” (Exhibit A), 9 unless otherwise agreed by the Designating Party or ordered by the court. Pages of 10 transcribed deposition testimony or exhibits to depositions that reveal Protected 11 Material may be separately bound by the court reporter and may not be disclosed to 12 anyone except as permitted under this Protective Order; and (i) any mediator or settlement officer, and their supporting personnel, 13 14 15 mutually agreed upon by any of the parties engaged in settlement discussions. 7.3 Disclosure of “HIGHLY CONFIDENTIAL -- ATTORNEYS’ EYES 16 ONLY” Information or Items. Unless otherwise ordered by the court or permitted in 17 writing by the Designating Party, a Receiving Party may disclose any information or 18 item designated “HIGHLY CONFIDENTIAL -- ATTORNEYS’ EYES ONLY” 19 only to: 20 (a) the Receiving Party’s Outside Counsel of Record in this Action, as well 21 as employees of said Outside Counsel of Record to whom it is reasonably necessary 22 to disclose the information for this Action; 23 (b) Experts (as defined in this Order) of the Receiving Party to whom 24 disclosure is reasonably necessary for this Action and who have signed the 25 “Acknowledgment and Agreement to Be Bound” (Exhibit A); 26 (c) the court and its personnel; 27 (d) private court reporters and their staff to whom disclosure is reasonably 28 necessary for this Action and who have signed the “Acknowledgment and 9 1 2 3 Agreement to Be Bound” (Exhibit A); (e) professional jury or trial consultants, mock jurors, and Professional 4 Vendors to whom disclosure is reasonably necessary for this Action and who have 5 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 6 7 8 9 10 (f) the author or recipient of a document containing the information or a custodian or other person who otherwise possessed or knew the information; and (g) any mediator or settlement officer, and their supporting personnel, mutually agreed upon by any of the parties engaged in settlement discussions. Nothing in this Order shall bar Counsel from rendering advice to his, her or 11 their client(s) with respect to this Action and, in the course thereof, relying upon any 12 information designated as Highly Confidential – Attorneys Eyes Only, provided that 13 the specific contents of the designated information will not be disclosed to the 14 client(s). 15 8. 16 17 PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED IN OTHER LITIGATION If a Party is served with a subpoena or a court order issued in other litigation 18 that compels disclosure of any information or items designated in this Action as 19 “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL -- ATTORNEYS’ EYES 20 ONLY,” that Party must: 21 22 23 (a) promptly notify in writing the Designating Party. Such notification shall include a copy of the subpoena or court order unless prohibited by law; (b) promptly notify in writing the party who caused the subpoena or order 24 to issue in the other litigation that some or all of the material covered by the 25 subpoena or order is subject to this Protective Order. Such notification shall include 26 a copy of this Protective Order; and 27 28 (c) cooperate with respect to all reasonable procedures sought to be pursued by the Designating Party whose Protected Material may be affected. 10 1 2 If the Designating Party timely seeks a protective order, the Party served with 3 the subpoena or court order shall not produce any information designated in this 4 action as “CONFIDENTIAL” or “HIGHLY CONFIDENTIAL -- ATTORNEYS’ 5 EYES ONLY” before a determination by the court from which the subpoena or 6 order issued, unless the Party has obtained the Designating Party’s permission, or 7 unless otherwise required by the law or court order. The Designating Party shall 8 bear the burden and expense of seeking protection in that court of its confidential 9 material and nothing in these provisions should be construed as authorizing or 10 encouraging a Receiving Party in this Action to disobey a lawful directive from 11 another court. 12 9. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE 13 PRODUCED IN THIS LITIGATION 14 (a) The terms of this Order are applicable to information produced by a 15 Non-Party in this Action and designated as “CONFIDENTIAL” or “HIGHLY 16 CONFIDENTIAL -- ATTORNEYS’ EYES ONLY.” Such information produced by 17 Non-Parties in connection with this litigation is protected by the remedies and relief 18 provided by this Order. Nothing in these provisions should be construed as 19 prohibiting a Non-Party from seeking additional protections. 20 (b) In the event that a Party is required, by a valid discovery request, to 21 produce a Non-Party’s confidential information in its possession, and the Party is 22 subject to an agreement with the Non-Party not to produce the Non-Party’s 23 confidential information, then the Party shall: 24 (1) promptly notify in writing the Requesting Party and the Non-Party 25 that some or all of the information requested is subject to a confidentiality 26 agreement with a Non-Party; 27 28 (2) promptly provide the Non-Party with a copy of the Protective Order in this Action, the relevant discovery request(s), and a reasonably specific 11 1 2 description of the information requested; and (3) make the information requested available for inspection by the 3 4 Non-Party, if requested. (c) If a Non-Party represented by counsel fails to commence the process 5 6 called for by Local Rules 45-1 and 37-1, et seq. within 14 days of receiving the 7 notice and accompanying information or fails contemporaneously to notify the 8 Receiving Party that it has done so, the Receiving Party may produce the Non- 9 Party’s confidential information responsive to the discovery request. If an 10 unrepresented Non-Party fails to seek a protective order from this court within 14 11 days of receiving the notice and accompanying information, the Receiving Party 12 may produce the Non-Party’s confidential information responsive to the discovery 13 request. If the Non-Party timely seeks a protective order, the Receiving Party shall 14 not produce any information in its possession or control that is subject to the 15 confidentiality agreement with the Non-Party before a determination by the court 16 unless otherwise required by the law or court order. Absent a court order to the 17 contrary, the Non-Party shall bear the burden and expense of seeking protection in 18 this court of its Protected Material. 19 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL 20 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed 21 any information or item designed as “CONFIDENTIAL” to any person or in any 22 circumstance not authorized under this Protective Order, the Receiving Party must 23 immediately (a) notify in writing the Designating Party of the unauthorized 24 disclosures, (b) use its best efforts to retrieve all unauthorized copies of the 25 Protected Material, (c) inform the person or persons to whom unauthorized 26 disclosures were made of all the terms of this Order, and (d) request such person or 27 persons to execute the “Acknowledgment and Agreement to Be Bound” (Exhibit A). 28 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed any 12 1 2 information or item designated as “HIGHLY CONFIDENTIAL -- ATTORNEYS’ 3 EYES ONLY” to any person or in any circumstance not authorized under this 4 Protective Order, the Receiving Party must immediately (a) notify in writing the 5 Designating Party of the unauthorized disclosures, (b) notify the District Court in 6 writing of the unauthorized disclosures, and (c) use its best efforts to retrieve all 7 unauthorized copies of the Protected Material. A Receiving Party’s unauthorized 8 disclosure of Protected Material may expose the Receiving Party to sanctions and 9 contempt proceedings. 10 11. PROTECTED MATERIAL 11 12 INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE When a Producing Party gives notice to Receiving Parties that certain 13 inadvertently produced material is subject to a claim of privilege or other protection, 14 the obligations of the Receiving Parties are those set forth in Federal Rule of Civil 15 Procedure 26(b)(5)(B). This provision is not intended to modify whatever 16 procedure may be established in an e-discovery order that provides for production 17 without prior privilege review. Pursuant to Federal Rule of Evidence 502(d) and 18 (e), insofar as the parties reach an agreement on the effect of disclosure of a 19 communication or information covered by the attorney-client privilege or work 20 product protection, the parties may incorporate their agreement into this Protective 21 Order. 22 12. 23 12.1 Right to Further Relief. Nothing in this Order abridges the right of any 24 MISCELLANEOUS person to seek its modification by the Court in the future. 25 12.2 Right to Assert Other Objections. No Party waives any right it 26 otherwise would have to object to disclosing or producing any information or item 27 on any ground not addressed in this Protective Order. Similarly, no Party waives 28 any right to object on any ground to use in evidence of any of the material covered 13 1 2 3 by this Protective Order. 12.3 Filing Protected Material. A Party that seeks to file under seal any 4 Protected Material must comply with Civil Local Rule 79-5 and with any pertinent 5 orders of the assigned District Judge and Magistrate Judge. Protected Material may 6 only be filed under seal pursuant to a court order authorizing the sealing of the 7 specific Protected Material at issue. If a Party’s request to file Protected Material 8 under seal is denied by the court, then the Receiving Party may filethe information 9 in the public record unless otherwise instructed by the court. 10 13. FINAL DISPOSITION 11 Within 30 days after the final disposition of this Action, as defined in Section 12 4, each Receiving Party must return the document productions to the Producing 13 Party. The Receiving Party must submit a sworn written certification to the 14 Producing Party (and, if not the same person or entity, to the Designating Party) by 15 the 30-day deadline that (1) identifies (by category, where appropriate) the 16 documents productions that were returned and (2) affirms that the Receiving Party 17 has not retained the document productions in any format. 18 Counsel are entitled to retain an archival copy of all pleadings, motion papers, 19 trial, deposition and hearing transcripts, legal memoranda, correspondence, 20 deposition and trial exhibits, expert reports, attorney work product, and consultant 21 and expert work product, even if such materials contain Protected Material. Any 22 such archival copies that contain or constitute Protected Material remain subject to 23 this Protect Order as set forth in Section 4. 24 To be clear, nothing in this paragraph requires a Receiving Party to return or 25 turn over to the Producing Party any information that the Receiving Party claims is 26 covered by a privilege. 27 28 14 1 2 14. Any violation of this Order may be punished by any and all appropriate 3 measures including, without limitation, contempt proceedings and/or monetary 4 sanctions. 5 6 IT IS SO ORDERED. DATED: January 14, 2019 7 8 9 _________________________ Honorable Alicia G. Rosenberg United States Magistrate Judge 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 15 1 2 EXHIBIT A 3 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND 4 5 I, _____________________________ [print or type full name], of 6 _________________ [print or type full address], declare under penalty of perjury 7 that I have read in its entirety and understand the Protective Order that was issued 8 by the United States District Court for the Central District of California on 9 _________________________ in the case of 10 _____________________________________. I agree to comply with and to be 11 bound by all the terms of this Protective Order and I understand and acknowledge 12 that failure to so comply could expose me to sanctions and punishment in the nature 13 of contempt. I solemnly promise that I will not disclose in any manner any 14 information or item that is subject to this Protective Order to any person or entity 15 except in strict compliance with the provisions of this Order. 16 I further agree to submit to the jurisdiction of the United States District Court 17 for the Central District of California for the purpose of enforcing the terms of this 18 Protective Order, even if such enforcement proceedings occur after termination of 19 this action. I hereby appoint __________________________ [print or type full 20 name] of _______________________________________ [print or type full address 21 and telephone number] as my California agent for service of process in connection 22 with this action or any proceedings related to enforcement of this Protective Order. 23 Date: ______________________________________ 24 City and State where sworn and signed: _________________________________ 25 26 Printed name: _______________________________ 27 28 Signature: __________________________________ 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 17

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