Opinion

California Surgery Center, Inc. v. Unitedhealthcare, Inc.

Court
District Court, C.D. California
Filed
Feb 18, 2020
Cited by
0 cases
Authority
More cited than 17.9%

The opinion

2 cScYhLilVl@IAgr JsOmO.c o (mSBN: 308236)

sjoo@grsm.com

3 GORDON REES SCULLY MANSUKHANI, LLP

633 West Fifth Street, 52nd Floor

4 Los Angeles, CA 90071

Telephone: (213) 576-5000

5 Facsimile: (213) 680-4470

6 Attorneys for Defendants

UNITEDHEALTHCARE, INC. and

7 UNITEDHEALTHCARE INSURANCE COMPANY

8 GARY L. TYSCH (SBN: 128389)

gltysch@pacbell.net

9 LAW OFFICES OF GARY L. TYSCH

16133 Ventura Boulevard, Suite 580

10 Encino, CA 91436

Telephone: (818) 995-9555

11 Facsimile: (818) 995-9550

12 Attorneys for Plaintiffs

CALIFORNIA SURGERY CENTER, INC. and

13 CALIFORNIA SPINE AND PAIN INSTITUTE

14

UNITED STATES DISTRICT COURT

15

CENTRAL DISTRICT OF CALIFORNIA

16

17

CALIFORNIA SURGERY CENTER, ) CASE NO. 2:19-cv-02309-DDP

18 INC. and CALIFORNIA SPINE AND ) (AFMx)

PAIN INSTITUTE, ) District Judge: Hon. Dean D.

19 ) Pregerson

Plaintiff, ) Magistrate Judge: Hon. Alexander F.

20 ) MacKinnon

vs.

)

21

UNITEDHEALTHCARE, INC.; )

22 UNITEDHEALTHCARE INSURANCE ) REVISED STIPULATION AND

COMPANY; and DOES 1-20, inclusive, ) [PROPOSED] PROTECTIVE

23 ) ORDER

Defendants. )

24 )

) DISCOVERY MATTER

25 )

)

26 )

)

27

)

)

28

2 SURGERY CENTER, INC. and CALIFORNIA SPINE AND PAIN INSTITUTE

3 (collectively referred to as “Plaintiffs”) and Defendants UNITEDHEALTHCARE,

4 INC. and UNITEDHEALTHCARE INSURANCE COMPANY (collectively

5 referred to as “UHC”) (Plaintiffs and UHC are together referred to as “the

6 Parties”), by and through their counsel of record, that in order to facilitate the

7 exchange of information and documents which may be subject to confidentiality

8 limitations on disclosure due to federal laws, state laws, and privacy rights, the

9 Parties stipulate as follows:

10 1. In this Stipulation and Protective Order, the words set forth below

11 shall have the following meanings:

12 a. “Proceeding” means the above-entitled proceeding, United

13 States District Court for the Central District of California Case No. 2:19-cv-

14 02309-DDP (AFMx);

15 b. “Court” means District Judge Dean D. Pregerson, Magistrate

16 Judge Alexander F. MacKinnon, or any other Judge to which this Proceeding may

17 be assigned, including Court staff participating in such proceedings.

18 c. “Confidential” means any information which is in the

19 possession of a Designating Party who believes in good faith that such information

20 is entitled to confidential treatment under applicable law, including any patient

21 health information required to be kept confidential under any state or federal law,

22 including 45 C.F.R. Parts 160 and 164 promulgated pursuant to the Health

23 Insurance Portability and Accountability Act of 1996 (see 45 C.F.R. §§ 164.501 &

24 160.103).

25 d. “Confidential Materials” means any Documents, Testimony or

26 Information as defined below designated as “Confidential” pursuant to the

27 provisions of this Stipulation and Protective Order and includes, but is not limited

28 to, materials designated as “Attorney-Eyes Only”.

“Attorney-Eyes Only” means any Confidential Materials which

2 information should not be disclosed to anyone other than a Party’s attorney.

3 f. “Designating Party” means the Party that designates Materials

4 as “Confidential” or “Attorney-Eyes Only”.

5 g. “Disclose” or “Disclosed” or “Disclosure” means to reveal,

6 divulge, give, or make available Materials, or any part thereof, or any information

7 contained therein.

8 h. “Documents” means (i) any “Writing,” “Original,” and

9 “Duplicate” as those terms are defined by California Evidence Code Sections 250,

10 255, and 260, which have been produced in discovery in this Proceeding by any

11 person, and (ii) any copies, reproductions, or summaries of all or any part of the

12 foregoing.

13 i. “Information” means the content of Documents or Testimony.

14 j. “Testimony” means all depositions, declarations or other

15 testimony taken or used in this Proceeding.

16 2. The Designating Party shall have the right to designate as

17 “Confidential” any Documents, Testimony or Information that the Designating

18 Party in good faith believes to contain non-public information that is entitled to

19 confidential treatment under applicable law.

20 3. The Designating Party shall have the right to designate as “Attorney-

21 Eyes Only” any Confidential Materials that the Designating Party in good faith

22 believes to contain non-public information that is entitled to confidential treatment

23 under applicable law and that which should not be seen by any person other than a

24 Party’s attorney.

25 4. The entry of this Stipulation and Protective Order does not alter,

26 waive, modify, or abridge any right, privilege or protection otherwise available to

27 any Party with respect to the discovery of matters, including but not limited to any

28 Party’s right to assert the attorney-client privilege, the attorney work product

doctrine, or other privileges, or any Party’s right to contest any such assertion.

2 “Confidential” or “Attorney-Eyes Only” must be clearly so designated before the

3 Document, Testimony or Information is Disclosed or produced. The parties may

4 agree that the case name and number are to be part of the “Confidential” or

5 “Attorney-Eyes Only” designation. The “Confidential” or “Attorney-Eyes Only”

6 designation should not obscure or interfere with the legibility of the designated

7 Information.

8 a. For Documents (apart from transcripts of depositions or other

9 pretrial or trial proceedings), the Designating Party must affix the legend

10 “Confidential” and/or redact or obscure all confidential information on each page

11 of any Document containing such designated Confidential Material.

12 b. For Testimony given in depositions the Designating Party may

13 either:

14 i. identify on the record, before the close of the deposition,

15 as “Confidential” Testimony, by specifying all portions of the

16 Testimony that qualify as “Confidential;” or

17 ii. designate the entirety of the Testimony at the deposition

18 as “Confidential” (before the deposition is concluded) with the right

19 to identify more specific portions of the Testimony as to which

20 protection is sought within 30 days following receipt of the

21 deposition transcript. In circumstances where portions of the

22 deposition Testimony are designated for protection, the transcript

23 pages containing “Confidential” Information may be separately

24 bound by the court reporter, who must affix to the top of each page

25 the legend “Confidential,” as instructed by the Designating Party.

26 c. For Information produced in some form other than

27 Documents, and for any other tangible items, including, without limitation,

28 compact discs or DVDs, the Designating Party must affix in a prominent place on

the exterior of the container or containers in which the Information or item is

2 the Information or item warrant protection, the Designating Party, to the extent

3 practicable, shall identify the “Confidential” or “Attorney-Eyes Only” portions.

4 6. The inadvertent production by any of the undersigned Parties or non-

5 Parties to the Proceedings of any Document, Testimony or Information during

6 discovery in this Proceeding without a “Confidential” or “Attorney-Eyes Only”

7 designation, shall be without prejudice to any claim that such item is

8 “Confidential” or “Attorney-Eyes Only” and such Party shall not be held to have

9 waived any rights by such inadvertent production. In the event that any Document,

10 Testimony or Information that is subject to a “Confidential” or “Attorney-Eyes

11 Only” designation is inadvertently produced without such designation, the Party

12 that inadvertently produced the document shall give written notice of such

13 inadvertent production within twenty (20) days of discovery of the inadvertent

14 production, together with a further copy of the subject Document, Testimony or

15 Information designated as “Confidential” or “Attorney-Eyes Only” (the

16 “Inadvertent Production Notice”). Upon receipt of such Inadvertent Production

17 Notice, the Party that received the inadvertently produced Document, Testimony or

18 Information shall promptly destroy the inadvertently produced Document,

19 Testimony or Information and all copies thereof, or, at the expense of the

20 producing Party, return such together with all copies of such Document, Testimony

21 or Information to counsel for the producing Party and shall retain only the

22 “Confidential” or “Attorney-Eyes Only” designated Materials. Should the

23 receiving Party choose to destroy such inadvertently produced Document,

24 Testimony or Information, the receiving Party shall notify the producing Party in

25 writing of such destruction within ten (10) days of receipt of written notice of the

26 inadvertent production. This provision is not intended to apply to any inadvertent

27 production of any Information protected by attorney-client or work product

28 privileges. In the event that this provision conflicts with any applicable law

regarding waiver of confidentiality through the inadvertent production of

2 7. In the event that counsel for a Party receiving Documents, Testimony

3 or Information in discovery designated as “Confidential” or “Attorney-Eyes Only”

4 objects to such designation with respect to any or all of such items, said counsel

5 shall advise counsel for the Designating Party, in writing, of such objections, the

6 specific Documents, Testimony or Information to which each objection pertains,

7 and the specific reasons and support for such objections (the “Designation

8 Objections”). Counsel for the Designating Party shall have thirty (30) days from

9 receipt of the written Designation Objections to either (a) agree in writing to de-

10 designate Documents, Testimony or Information pursuant to any or all of the

11 Designation Objections and/or (b) file a motion with the Court seeking to uphold

12 any or all designations on Documents, Testimony or Information addressed by the

13 Designation Objections (the “Designation Motion”). Pending a resolution of the

14 Designation Motion by the Court, any and all existing designations on the

15 Documents, Testimony or Information at issue in such Motion shall remain in

16 place. The Designating Party shall have the burden on any Designation Motion of

17 establishing the applicability of its “Confidential” or “Attorney-Eyes Only”

18 designation. In the event that the Designation Objections are neither timely agreed

19 to nor timely addressed in the Designation Motion, then such Documents,

20 Testimony or Information shall be de-designated in accordance with the

21 Designation Objection applicable to such material.

22 8. Access to and/or Disclosure of Confidential Materials designated as

23 “Confidential” shall be permitted only to the following persons:

24 a. the Court;

25 b. (1) Attorneys of record in the Proceedings and their affiliated

26 attorneys, paralegals, clerical and secretarial staff employed by such attorneys who

27 are actively involved in the Proceedings and are not employees of any Party. (2)

28 In-house counsel to the undersigned Parties and the paralegal, clerical and

secretarial staff employed by such counsel. Provided, however, that each non-

2 are being Disclosed pursuant to, and are subject to, the terms of this Stipulation

3 and Protective Order and that they may not be Disclosed other than pursuant to its

4 terms;

5 c. those officers, directors, partners, members, employees and

6 agents of all non-designating Parties that counsel for such Parties deems necessary

7 to aid counsel in the prosecution and defense of this Proceeding; provided,

8 however, that prior to the Disclosure of Confidential Materials to any such officer,

9 director, partner, member, employee or agent, counsel for the Party making the

10 Disclosure shall deliver a copy of this Stipulation and Protective Order to such

11 person, shall explain that such person is bound to follow the terms of such Order,

12 and shall secure the signature of such person on a statement in the form attached

13 hereto as Exhibit A;

14 d. court reporters in this Proceeding (whether at depositions,

15 hearings, or any other proceeding);

16 e. any deposition, trial or hearing witness in the Proceeding who

17 previously has had access to the Confidential Materials, or who is currently or was

18 previously an officer, director, partner, member, employee or agent of an entity

19 that has had access to the Confidential Materials;

20 f. any deposition or non-trial hearing witness in the Proceeding

21 who previously did not have access to the Confidential Materials; provided,

22 however, that each such witness given access to Confidential Materials shall be

23 advised that such Materials are being Disclosed pursuant to, and are subject to, the

24 terms of this Stipulation and Protective Order and that they may not be Disclosed

25 other than pursuant to its terms;

26 g. mock jury participants, provided, however, that prior to the

27 Disclosure of Confidential Materials to any such mock jury participant, counsel for

28 the Party making the Disclosure shall deliver a copy of this Stipulation and

Protective Order to such person, shall explain that such person is bound to follow

2 statement in the form attached hereto as Exhibit A;

3 h. outside experts or expert consultants consulted by the

4 undersigned Parties or their counsel in connection with the Proceeding, whether or

5 not retained to testify at any oral hearing; provided, however, that prior to the

6 Disclosure of Confidential Materials to any such expert or expert consultant,

7 counsel for the Party making the Disclosure shall deliver a copy of this Stipulation

8 and Protective Order to such person, shall explain its terms to such person, and

9 shall secure the signature of such person on a statement in the form attached hereto

10 as Exhibit A. It shall be the obligation of counsel, upon learning of any breach or

11 threatened breach of this Stipulation and Protective Order by any such expert or

12 expert consultant, to promptly notify counsel for the Designating Party of such

13 breach or threatened breach;

14 i. third party witnesses whether or not they will testify at any oral

15 hearing; provided, however, that prior to the Disclosure of Confidential Materials

16 to any such third party witness, counsel for the Party making the Disclosure shall

17 deliver a copy of this Stipulation and Protective Order to such person, shall explain

18 its terms to such person, and shall secure the signature of such person on a

19 statement in the form attached hereto as Exhibit A; and

20 j. any other person that the Designating Party agrees to in writing.

21 9. Access to and/or Disclosure of Confidential Materials designated as

22 “Attorney-Eyes Only” shall be permitted only to the following persons:

23 (1) Attorneys of record in the Proceedings and their affiliated

24 attorneys, paralegals, clerical and secretarial staff employed by such

25 attorneys who are actively involved in the Proceedings and are not

26 employees of any Party.

27 (2) In-house counsel to the undersigned Parties and the paralegal,

28 clerical and secretarial staff employed by such counsel. Provided,

however, that each non-lawyer given access to Confidential Materials

2 and are subject to, the terms of this Stipulation and Protective Order

3 and that they may not be Disclosed other than pursuant to its terms.

4 10. Confidential Materials shall be used by the persons receiving them

5 only for the purposes of preparing for, conducting, participating in the conduct of,

6 and/or prosecuting and/or defending the Proceeding, and not for any business or

7 other purpose whatsoever.

8 11. Any Party to the Proceeding (or other person subject to the terms of

9 this Stipulation and Protective Order) may ask the Court, after appropriate notice to

10 the other Parties to the Proceeding, to modify or grant relief from any provision of

11 this Stipulation and Protective Order.

12 12. Entering into, agreeing to, and/or complying with the terms of this

13 Stipulation and Protective Order shall not:

14 a. operate as an admission by any person that any particular

15 Document, Testimony or Information marked “Confidential” or “Attorney-Eyes

16 Only” contains or reflects trade secrets, proprietary, confidential or competitively

17 sensitive business, commercial, financial or personal information; or

18 b. prejudice in any way the right of any Party (or any other

19 person subject to the terms of this Stipulation and Protective Order):

20 i. to seek a determination by the Court of whether any

21 particular Confidential Material should be subject to protection as

22 “Confidential” or “Attorney-Eyes Only” under the terms of this

23 Stipulation and Protective Order; or

24 ii. to seek relief from the Court on appropriate notice to all

25 other Parties to the Proceeding from any provision(s) of this

26 Stipulation and Protective Order, either generally or as to any

27 particular Document, Material or Information.

28 / /

/ /

2 Protective Order as of the time it is presented to the Court for signature may

3 thereafter become a Party to this Stipulation and Protective Order by its counsel’s

4 signing and dating a copy thereof and filing the same with the Court, and serving

5 copies of such signed and dated copy upon the other Parties to this Stipulation and

6 Protective Order.

7 14. Any Information that may be produced by a non-Party witness in

8 discovery in the Proceeding pursuant to subpoena or otherwise may be designated

9 by such non-Party as “Confidential” or “Attorney-Eyes Only” under the terms of

10 this Stipulation and Protective Order, and any such designation by a non-Party

11 shall have the same force and effect, and create the same duties and obligations, as

12 if made by one of the undersigned Parties hereto. Any such designation shall also

13 function as a consent by such producing Party to the authority of the Court in the

14 Proceeding to resolve and conclusively determine any motion or other application

15 made by any person or Party with respect to such designation, or any other matter

16 otherwise arising under this Stipulation and Protective Order.

17 15. If any person subject to this Stipulation and Protective Order who has

18 custody of any Confidential Materials receives a subpoena or other process

19 (“Subpoena”) from any government or other person or entity demanding

20 production of Confidential Materials, the recipient of the Subpoena shall promptly

21 give notice of the same by electronic mail transmission, followed by either express

22 mail or overnight delivery to counsel of record for the Designating Party, and shall

23 furnish such counsel with a copy of the Subpoena. Upon receipt of this notice, the

24 Designating Party may, in its sole discretion and at its own cost, move to quash or

25 limit the Subpoena, otherwise oppose production of the Confidential Materials,

26 and/or seek to obtain confidential treatment of such Confidential Materials from

27 the subpoenaing person or entity to the fullest extent available under law. The

28 recipient of the Subpoena may not produce any Documents, Testimony or

Information pursuant to the Subpoena prior to the date specified for production on

2 16. Nothing in this Stipulation and Protective Order shall be construed to

3 preclude either Party from asserting in good faith that certain Confidential

4 Materials require additional protection. The Parties shall meet and confer to agree

5 upon the terms of such additional protection.

6 17. If, after execution of this Stipulation and Protective Order, any

7 Confidential Materials submitted by a Designating Party under the terms of this

8 Stipulation and Protective Order is Disclosed by a non-Designating Party to any

9 person other than in the manner authorized by this Stipulation and Protective

10 Order, the non-Designating Party responsible for the Disclosure shall bring all

11 pertinent facts relating to the Disclosure of such Confidential Materials to the

12 immediate attention of the Designating Party.

13 18. This Stipulation and Protective Order is entered into without prejudice

14 to the right of any Party to knowingly waive the applicability of this Stipulation

15 and Protective Order to any Confidential Materials designated by that Party. If the

16 Designating Party uses Confidential Materials in a non-Confidential manner, then

17 the Designating Party shall advise that the designation no longer applies.

18 19. The Parties shall meet and confer regarding the procedures for use of

19 Confidential Materials during the Proceeding and shall seek the entry of an

20 appropriate order, if necessary.

21 20. Nothing in this Stipulation and Protective Order shall affect the

22 admissibility into evidence of Confidential Materials, or abridge the rights of any

23 person to seek judicial review or to pursue other appropriate judicial action with

24 respect to any ruling made by the Court concerning the issue of the status of

25 Protected Material.

26 21. This Stipulation and Protective Order shall continue to be binding

27 after the conclusion of this Proceeding and all subsequent proceedings arising from

28 this Proceeding, except that a Party may seek the written permission of the

Designating Party or may move the Court for relief from the provisions of this

2 retain jurisdiction to enforce, modify, or reconsider this Stipulation and Protective

3 Order, even after the Proceeding is terminated.

4 22. Upon written request made within thirty (30) days after the settlement

5 or other termination of the Proceeding, the undersigned Parties shall have thirty

6 (30) days to either (a) promptly return to counsel for each Designating Party all

7 Confidential Materials and all copies thereof (except that counsel for each Party

8 may maintain in its files, in continuing compliance with the terms of this

9 Stipulation and Protective Order, all work product, and one copy of each pleading

10 filed with the Court [and one copy of each deposition together with the exhibits

11 marked at the deposition)]*, (b) agree with counsel for the Designating Party upon

12 appropriate methods and certification of destruction or other disposition of such

13 Confidential Materials, or (c) as to any Documents, Testimony or other

14 Information not addressed by sub-paragraphs (a) and (b), file a motion seeking a

15 Court order regarding proper preservation of such Materials. To the extent

16 permitted by law the Court shall retain continuing jurisdiction to review and rule

17 upon the motion referred to in sub-paragraph (c) herein. *[The bracketed portion of

18 this provision shall be subject to agreement between counsel for the Parties in each

19 case.]

20 23. After this Stipulation and Protective Order has been signed by counsel

21 for all Parties, it shall be presented to the Court for entry. Counsel agree to be

22 bound by the terms set forth herein with regard to any Confidential Materials that

23 have been produced before the Court signs this Stipulation and Protective Order.

24 24. The Parties and all signatories to the Certification attached hereto as

25 Exhibit A agree to be bound by this Stipulation and Protective Order pending its

26 approval and entry by the Court. In the event that the Court modifies this

27 Stipulation and Protective Order, or in the event that the Court enters a different

28 Protective Order, the Parties agree to be bound by this Stipulation and Protective

Order until such time as the Court may enter such a different Order. It is the

2 pending its entry so as to allow for immediate production of Confidential Materials

3 under the terms herein.

4 25. The Court may only enter a protective order upon a showing of good

5 cause. See Kamakana v. City and County of Honolulu, 447 F.3d 1172, 1176 (9th

6 Cir. 2006). Here, good cause exists for the entry of a protective order because the

7 information in this matter contained in the Documents involves patient personal

8 health information, which is protected by the Health Insurance Portability and

9 Accountability Act (HIPAA) and the right to privacy. A protective order is

10 therefore necessary to ensure the confidential information is protected.

11 26. This Stipulation and Protective Order does not govern the use of

12 confidential information at trial. Use of confidential information at trial shall be

13 governed by orders of the trial judge.

14 27. Under Seal Filings: Parties shall make every effort to limit the number

15 and volume of under seal filings. In most circumstances, parties should seek to file

16 under seal only the specific portions or exhibits or documents for which there is a

17 valid basis for filing under seal. Requests to file memoranda of points and

18 authorities under seal are disfavored. Pursuant to Local Rule 79-5.2.2, except in

19 sealed civil cases, “no document may be filed under seal without prior approval by

20 the Court.” When seeking the Court’s approval for an under-seal filing, the

21 submitting party shall comply with the procedures established in Local Rule 79-

22 5.2.2(a). Because documents filed under seal are only visible on CM/ECF or Pacer

23 to Court personnel and the party that filed the document, a party electronically

24 filing a document under seal may not rely on the Court’s CM/ECF System to effect

25 service as provided in Local Rule 5-3.2.1. Therefore, documents filed

26 electronically under seal must be served in accordance with Federal Rule of Civil

27 Procedure 5.

28 / /

/ /

1 This Stipulation and Protective Order may be executed in counterparts.

2 ||Dated: February 4, 2020 GORDON REES SCULLY

3 MANSUKHANI, LLP

4 By: Sylvia Joo

5 Courtney C. Hill

Sylvia Joo

6 Attorneys for Defendants

4 UNITEDHEALTHCARE, INC.

and UNITEDHEALTHCARE

8 INSURANCE COMPANY

9 ||Dated: February 4, 2020 LAW OFFICES OF GARY L. TYSCH

10

ul By: /4s/Gary L. Tysch

Gary L. Tysch

12 Attorney for Plaintiffs

CALIFORNIA SURGERY

= 13 CENTER, INC. AND

CALIFORNIA SPINE AND PAIN

14 INSTITUTE

15 || Filer’s Attestation: Pursuant to Local Rule 5-4.3.4(a)(2)(i) regarding signatures, I,

16 || Sylvia Joo, hereby attest that all other signatories listed concur in the content of

2 17 || this document and have authorized its filing.

18

/s/ Sylvia Joo

19 ylvia Joo

20 ORDER

21 GOOD CAUSE APPEARING, the Court hereby approves this Stipulation

22 || and Protective Order.

23 IT IS SO ORDERED. °

24

25 || Dated: 2/18/2020

Alexander F. MacKinnon

26 United States Magistrate Judge

27

28

1A.

2 EXHIBIT A

3 CERTIFICATION RE CONFIDENTIAL DISCOVERY MATERIALS

4 I hereby acknowledge that I, ____________[NAME],

5 ___________________ [POSITION AND EMPLOYER], am about to receive

6 Confidential Materials supplied in connection with the Proceeding, Central District

7 of California Case No. 2:19-cv-02309-DDP (AFMx). I certify that I understand

8 that the Confidential Materials are provided to me subject to the terms and restrict-

9 ions of the Stipulation and Protective Order filed in this Proceeding. I have been

10 given a copy of the Stipulation and Protective Order; I have read it, and I agree to

11 be bound by its terms. I understand that Confidential Materials, as defined in the

12 Stipulation and Protective Order, including any notes or other records that may be

13 made regarding any such materials, shall not be Disclosed to anyone except as

14 expressly permitted by the Stipulation and Protective Order. I will not copy or use,

15 except solely for the purposes of this Proceeding, any Confidential Materials

16 obtained pursuant to this Protective Order, except as provided therein or otherwise

17 ordered by the Court in the Proceeding. I further understand that I am to retain all

18 copies of all Confidential Materials provided to me in the Proceeding in a secure

19 manner, and that all copies of such Materials are to remain in my personal custody

20 until termination of my participation in this Proceeding, whereupon the copies of

21 such Materials will be returned to counsel who provided me with such Materials.

22 I declare under penalty of perjury, under the laws of the United States of

23 America that the foregoing is true and correct. Executed this _____ day of

24 _________, 20__, at _________________.

25 DATED: BY:

Signature

26

Title

27

Address -City, State, Zip

28

Telephone Number

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