distinguishing “good cause” showing for sealing 15 documents produced in discovery from “compelling reasons” standard when merits-related 16 documents are part of court record
How later courts described this case
- distinguishing “good cause” showing for sealing 15 documents produced in discovery from “compelling reasons” standard when merits-related 16 documents are part of court record
- even stipulated protective orders require good cause showing
Written by the judges who cited it.
The opinion
1 GRAHAMHOLLIS APC
Graham S.P. Hollis (SBN 120577)
2 ghollis@grahamhollis.com
Vilmarie Cordero (SBN 268860)
3 vcordero@grahamhollis.com
Hali M. Anderson (SBN 261816)
4 handerson@grahamhollis.com
David X. Lin (SBN 312350)
5 dlin@grahamhollis.com
3555 Fifth Avenue Suite 200
6 San Diego, California 92103
Telephone: 619.692.0800
7 Facsimile: 619.692.0822
8 Attorneys for Plaintiff, STEPHEN
CARTWRIGHT
9
UNITED STATES DISTRICT COURT
10
CENTRAL DISTRICT OF CALIFORNIA
11
STEPHEN CARTWRIGHT on behalf of Case No.: 2:21−cv−05049 RGK (PDx)
12 all other similarly-situated employees in
the State of California,
13 STIPULATED PROTECTIVE ORDER
Plaintiff,
14 Department: 850
15 v. Judge: The Honorable R. Gary Klausner
16 E THN RV OO UY G A HIR 5, 0 I ,N inC c. l; u a sn ivd e D , OES 1 Removed from State Court: June 21, 2021
17 Amended Complaint Filed: June 14, 2021
Complaint Filed: April 1, 2021
Trial Date: None Set
18 Defendants.
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25
26
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28 STIPULATED PROTECTIVE ORDER
1 A. PURPOSES AND LIMITATIONS
2 Discovery in this action is likely to involve production of confidential, proprietary
3 or private information for which special protection from public disclosure and from use for
4 any purpose other than prosecuting this litigation may be warranted. Accordingly, the
5 parties hereby stipulate to and petition the Court to enter the following Stipulated Protective
6 Order. The parties acknowledge that this Order does not confer blanket protections on all
7 disclosures or responses to discovery and that the protection it affords from public
8 disclosure and use extends only to the limited information or items that are entitled to
9 confidential treatment under the applicable legal principles.
10 B. GOOD CAUSE STATEMENT
11 This action is likely to involve commercial, financial, technical and/or proprietary
12 information, including the names, contact information, payroll, wage statement, and
13 timekeeping records for Defendant’s non-exempt employees, for which special protection
14 from public disclosure and from use for any purpose other than prosecution of this action
15 is warranted. Such confidential and proprietary materials and information consist of,
16 among other things, confidential business or financial information, information regarding
17 confidential business practices, and sensitive personal information of putative class
18 members and percipient witnesses otherwise generally unavailable to the public, or which
19 may be privileged or otherwise protected from disclosure under state or federal statutes,
20 court rules, case decisions, or common law. Accordingly, to expedite the flow of
21 information, to facilitate the prompt resolution of disputes over confidentiality of discovery
22 materials, to adequately protect information the parties are entitled to keep confidential, to
23 ensure that the parties are permitted reasonable necessary uses of such material in
24 preparation for and in the conduct of trial, to address their handling at the end of the
25 litigation, and serve the ends of justice, a protective order for such information is justified
26 in this matter. It is the intent of the parties that information will not be designated as
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1 confidential for tactical reasons and that nothing be so designated without a good faith
2 belief that it has been maintained in a confidential non-public manner, and there is good
3 cause why it should not be part of the public record of this case.
4 C. ACKNOWLEDGMENT OF PROCEDURE FOR FILING UNDER SEAL
5 The parties further acknowledge, as set forth in Section 12.3, below, that this
6 Stipulated Protective Order does not entitle them to file confidential information under
7 seal; Local Civil Rule 79-5 sets forth the procedures that must be followed and the
8 standards that will be applied when a party seeks permission from the court to file material
9 under seal.
10 There is a strong presumption that the public has a right of access to judicial
11 proceedings and records in civil cases. In connection with non-dispositive motions, good
12 cause must be shown to support a filing under seal. See Kamakana v. City and County of
13 Honolulu, 447 F.3d 1172, 1176 (9th Cir. 2006), Phillips v. Gen. Motors Corp., 307 F.3d
14 1206, 1210-11 (9th Cir. 2002), Makar-Welbon v. Sony Electrics, Inc., 187 F.R.D. 576, 577
15 (E.D. Wis. 1999) (even stipulated protective orders require good cause showing). A
16 specific showing of good cause or compelling reasons with proper evidentiary support and
17 legal justification, must be made with respect to Protected Material that a party seeks to
18 file under seal. The parties’ mere designation of Disclosure or Discovery Material as
19 CONFIDENTIAL does not—without the submission of competent evidence by
20 declaration, establishing that the material sought to be filed under seal qualifies as
21 confidential, privileged, or otherwise protectable—constitute good cause.
22 Further, if a party requests sealing related to a dispositive motion or trial, then
23 compelling reasons, not only good cause, for the sealing must be shown, and the relief
24 sought shall be narrowly tailored to serve the specific interest to be protected. See Pintos
25 v. Pacific Creditors Ass’n., 605 F.3d 665, 677-79 (9th Cir. 2010). For each item or type of
26 information, document, or thing sought to be filed or introduced under seal in connection
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1 with a dispositive motion or trial, the party seeking protection must articulate compelling
2 reasons, supported by specific facts and legal justification, for the requested sealing order.
3 Again, competent evidence supporting the application to file documents under seal must
4 be provided by declaration.
5 Any document that is not confidential, privileged, or otherwise protectable in its
6 entirety will not be filed under seal if the confidential portions can be redacted. If
7 documents can be redacted, then a redacted version for public viewing, omitting only the
8 confidential, privileged, or otherwise protectable portions of the document, shall be filed.
9 Any application that seeks to file documents under seal in their entirety should include an
10 explanation of why redaction is not feasible.
11 2. DEFINITIONS
12 2.1 Action: Stephen Cartwright v. Envoy Air, Inc., District Court of California,
13 Central District, Case No. 2:21−cv−05049 RGK (PDx).
14 2.2 Challenging Party: a Party or Non-Party that challenges the designation of
15 information or items under this Order.
16 2.3 “CONFIDENTIAL” Information or Items: information (regardless of how
17 it is generated, stored or maintained) or tangible things that qualify for protection under
18 Federal Rule of Civil Procedure 26(c), and as specified above in the Good Cause Statement.
19 2.4 Counsel: Outside Counsel of Record and House Counsel (as well as their
20 support staff).
21 2.5 Designating Party: a Party or Non-Party that designates information or items
22 that it produces in disclosures or in responses to discovery as “CONFIDENTIAL.”
23 2.6 Disclosure or Discovery Material: all items or information, regardless of the
24 medium or manner in which it is generated, stored, or maintained (including, among other
25 things, testimony, transcripts, and tangible things), that are produced or generated in
26 disclosures or responses to discovery in this matter.
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1 2.7 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 an
3 expert witness or as a consultant in this Action.
4 2.8 House Counsel: attorneys who are employees of a party to this Action. House
5 Counsel does not include Outside Counsel of Record or any other outside counsel.
6 2.9 Non-Party: any natural person, partnership, corporation, association or other
7 legal entity not named as a Party to this action.
8 2.10 Outside Counsel of Record: attorneys who are not employees of a party to this
9 Action but are retained to represent or advise a party to this Action and have appeared in
10 this Action on behalf of that party or are affiliated with a law firm that has appeared on
11 behalf of that party, and includes support staff.
12 2.11 Party: any party to this Action, including all of its officers, directors,
13 employees, consultants, retained experts, and Outside Counsel of Record (and their support
14 staffs).
15 2.12 Producing Party: a Party or Non-Party that produces Disclosure or Discovery
16 Material in this Action.
17 2.13 Professional Vendors: persons or entities that provide litigation support
18 services (e.g., photocopying, videotaping, translating, preparing exhibits or
19 demonstrations, and organizing, storing, or retrieving data in any form or medium) and
20 their employees and subcontractors.
21 2.14 Protected Material: any Disclosure or Discovery Material that is designated
22 as “CONFIDENTIAL.”
23 2.15 Receiving Party: a Party that receives Disclosure or Discovery Material from
24 a Producing Party.
25 3. SCOPE
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1 The protections conferred by this Stipulation and Order cover not only Protected
2 Material (as defined above), but also (1) any information copied or extracted from
3 Protected Material; (2) all copies, excerpts, summaries, or compilations of Protected
4 Material; and (3) any testimony, conversations, or presentations by Parties or their Counsel
5 that might reveal Protected Material.
6 Any use of Protected Material at trial shall be governed by the orders of the trial
7 judge. This Order does not govern the use of Protected Material at trial.
8 4. DURATION
9 Once a case proceeds to trial, information that was designated as
10 CONFIDENTIAL or maintained pursuant to this protective order used or introduced as an
11 exhibit at trial becomes public and will be presumptively available to all members of the
12 public, including the press, unless compelling reasons supported by specific factual
13 findings to proceed otherwise are made to the trial judge in advance of the trial. See
14 Kamakana, 447 F.3d at 1180-81 (distinguishing “good cause” showing for sealing
15 documents produced in discovery from “compelling reasons” standard when merits-related
16 documents are part of court record). Accordingly, the terms of this protective order do not
17 extend beyond the commencement of the trial.
18 5. DESIGNATING PROTECTED MATERIAL
19 5.1 Exercise of Restraint and Care in Designating Material for Protection. Each
20 Party or Non-Party that designates information or items for protection under this Order
21 must take care to limit any such designation to specific material that qualifies under the
22 appropriate standards. The Designating Party must designate for protection only those
23 parts of material, documents, items or oral or written communications that qualify so that
24 other portions of the material, documents, items or communications for which protection
25 is not warranted are not swept unjustifiably within the ambit of this Order.
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1 Mass, indiscriminate or routinized designations are prohibited. Designations that are
2 shown to be clearly unjustified or that have been made for an improper purpose (e.g., to
3 unnecessarily encumber the case development process or to impose unnecessary expenses
4 and burdens on other parties) may expose the Designating Party to sanctions.
5 If it comes to a Designating Party’s attention that information or items that it
6 designated for protection do not qualify for protection, that Designating Party must
7 promptly notify all other Parties that it is withdrawing the inapplicable designation.
8 5.2 Manner and Timing of Designations. Except as otherwise provided in this
9 Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise stipulated or
10 ordered, Disclosure or Discovery Material that qualifies for protection under this Order
11 must be clearly so designated before the material is disclosed or produced.
12 Designation in conformity with this Order requires:
13 (a) for information in documentary form (e.g., paper or electronic
14 documents, but excluding transcripts of depositions or other pretrial or trial proceedings),
15 that the Producing Party affix at a minimum, the legend
16 “CONFIDENTIAL” (hereinafter “CONFIDENTIAL legend”), to each page that contains
17 protected material. If only a portion of the material on a page qualifies for protection, the
18 Producing Party also must clearly identify the protected portion(s) (e.g., by making
19 appropriate markings in the margins).
20 A Party or Non-Party that makes original documents available for inspection need
21 not designate them for protection until after the inspecting Party has indicated which
22 documents it would like copied and produced. During the inspection and before the
23 designation, all of the material made available for inspection shall be deemed
24 “CONFIDENTIAL.” After the inspecting Party has identified the
25 documents it wants copied and produced, the Producing Party must determine which
26 documents, or portions thereof, qualify for protection under this Order. Then, before
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1 producing the specified documents, the Producing Party must affix the “CONFIDENTIAL
2 legend” to each page that contains Protected Material. If only a portion of the material on
3 a page qualifies for protection, the Producing Party also must clearly identify the protected
4 portion(s) (e.g., by making appropriate markings in the margins).
5 (b) for testimony given in depositions that the Designating Party identifies
6 the Disclosure or Discovery Material on the record, before the close of the deposition all
7 protected testimony.
8 (c) for information produced in some form other than documentary and for
9 any other tangible items, that the Producing Party affix in a prominent place on the exterior
10 of the container or containers in which the information is stored the legend
11 “CONFIDENTIAL.” If only a portion or portions of the information warrants
12 protection, the Producing Party, to the extent practicable, shall identify the protected
13 portion(s).
14 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent failure
15 to designate qualified information or items does not, standing alone, waive the Designating
16 Party’s right to secure protection under this Order for such material. Upon timely correction
17 of a designation, the Receiving Party must make reasonable efforts to assure that the
18 material is treated in accordance with the provisions of this Order.
19 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS
20 6.1 Timing of Challenges. Any Party or Non-Party may challenge a designation
21 of confidentiality at any time that is consistent with the Court’s Scheduling Order.
22 6.2 Meet and Confer. The Challenging Party shall initiate the dispute resolution
23 process under Local Rule 37-1 et seq.
24 6.3 Joint Stipulation. Any challenge submitted to the Court shall be via a joint
25 stipulation pursuant to Local Rule 37-2.
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1 6.4 The burden of persuasion in any such challenge proceeding shall be on the
2 Designating Party. Frivolous challenges, and those made for an improper purpose (e.g., to
3 harass or impose unnecessary expenses and burdens on other parties) may expose the
4 Challenging Party to sanctions. Unless the Designating Party has waived or withdrawn the
5 confidentiality designation, all parties shall continue to afford the material in question the
6 level of protection to which it is entitled under the Producing Party’s designation until the
7 Court rules on the challenge.
8 7. ACCESS TO AND USE OF PROTECTED MATERIAL
9 7.1 Basic Principles. A Receiving Party may use Protected Material that is
10 disclosed or produced by another Party or by a Non-Party in connection with this Action
11 only for prosecuting, defending or attempting to settle this Action. Such Protected
12 Material may be disclosed only to the categories of persons and under the conditions
13 described in this Order. When the Action has been terminated, a Receiving Party must
14 comply with the provisions of section 13 below (FINAL DISPOSITION).
15 Protected Material must be stored and maintained by a Receiving Party at a location
16 and in a secure manner that ensures that access is limited to the persons authorized under
17 this Order.
18 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless otherwise
19 ordered by the court or permitted in writing by the Designating Party, a Receiving Party
20 may disclose any information or item designated “CONFIDENTIAL” only
21 to:
22 (a) the Receiving Party’s Outside Counsel of Record in this Action, as well as
23 employees of said Outside Counsel of Record to whom it is reasonably necessary to
24 disclose the information for this Action;
25 (b) the officers, directors, and employees (including House Counsel) of the
26 Receiving Party to whom disclosure is reasonably necessary for this Action;
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1 (c) Experts (as defined in this Order) of the Receiving Party to whom disclosure
2 is reasonably necessary for this Action and who have signed the “Acknowledgment and
3 Agreement to Be Bound” (Exhibit A);
4 (d) the court and its personnel;
5 (e) court reporters and their staff;
6 (f) professional jury or trial consultants, mock jurors, and Professional Vendors to
7 whom disclosure is reasonably necessary for this Action and who have signed the
8 “Acknowledgment and Agreement to Be Bound” (attached hereto as Exhibit A);
9 (g) the author or recipient of a document containing the information or a custodian
10 or other person who otherwise possessed or knew the information;
11 (h) during their depositions, witnesses, and attorneys for witnesses, in the Action to
12 whom disclosure is reasonably necessary provided: (1) the deposing party requests that the
13 witness sign the form attached as Exhibit 1 hereto; and (2) they will not be permitted to
14 keep any confidential information unless they sign the “Acknowledgment and Agreement
15 to Be Bound” (Exhibit A), unless otherwise agreed by the Designating Party or ordered by
16 the court. Pages of transcribed deposition testimony or exhibits to depositions that reveal
17 Protected Material may be separately bound by the court reporter and may not be disclosed
18 to anyone except as permitted under this Stipulated Protective Order; and
19 (i) any mediator or settlement officer, and their supporting personnel, mutually
20 agreed upon by any of the parties engaged in settlement discussions.
21 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED PRODUCED
22 IN OTHER LITIGATION
23 If a Party is served with a subpoena or a court order issued in other litigation that
24 compels disclosure of any information or items designated in this Action as
25 “CONFIDENTIAL,” that Party must:
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1 (a) promptly notify in writing the Designating Party. Such notification shall
2 include a copy of the subpoena or court order;
3 (b) promptly notify in writing the party who caused the subpoena or order to issue
4 in the other litigation that some or all of the material covered by the subpoena or order is
5 subject to this Protective Order. Such notification shall include a copy of this Stipulated
6 Protective Order; and
7 (c) cooperate with respect to all reasonable procedures sought to be pursued by
8 the Designating Party whose Protected Material may be affected.
9 If the Designating Party timely seeks a protective order, the Party served with the
10 subpoena or court order shall not produce any information designated in this action as
11 “CONFIDENTIAL” before a determination by the court from which the subpoena or order
12 issued, unless the Party has obtained the Designating Party’s permission. The
13 Designating Party shall bear the burden and expense of seeking protection in that court of
14 its confidential material and nothing in these provisions should be construed as authorizing
15 or encouraging a Receiving Party in this Action to disobey a lawful directive from another
16 court.
17 9. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE
18 PRODUCED IN THIS LITIGATION
19 (a) The terms of this Order are applicable to information produced by a
20 Non-Party in this Action and designated as “CONFIDENTIAL.” Such information
21 produced by Non-Parties in connection with this litigation is protected by the remedies and
22 relief provided by this Order. Nothing in these provisions should be construed as
23 prohibiting a Non-Party from seeking additional protections.
24 (b) In the event that a Party is required, by a valid discovery request, to produce
25 a Non-Party’s confidential information in its possession, and the Party is subject to an
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1 agreement with the Non-Party not to produce the Non-Party’s confidential information,
2 then the Party shall:
3 (1) promptly notify in writing the Requesting Party and the Non-Party that
4 some or all of the information requested is subject to a confidentiality agreement with a
5 Non-Party;
6 (2) promptly provide the Non-Party with a copy of the Stipulated
7 Protective Order in this Action, the relevant discovery request(s), and a reasonably specific
8 description of the information requested; and
9 (3) make the information requested available for inspection by the Non-
10 Party, if requested.
11 (c) If the Non-Party fails to seek a protective order from this court within 14 days
12 of receiving the notice and accompanying information, the Receiving Party may produce
13 the Non-Party’s confidential information responsive to the discovery request. If the Non-
14 Party timely seeks a protective order, the Receiving Party shall not produce any
15 information in its possession or control that is subject to the confidentiality agreement with
16 the Non-Party before a determination by the court. Absent a court order to the contrary, the
17 Non-Party shall bear the burden and expense of seeking protection in this court of its
18 Protected Material.
19 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL
20 If a Receiving Party learns that, by inadvertence or otherwise, it has disclosed
21 Protected Material to any person or in any circumstance not authorized under this
22 Stipulated Protective Order, the Receiving Party must immediately (a) notify in writing the
23 Designating Party of the unauthorized disclosures, (b) use its best efforts to retrieve all
24 unauthorized copies of the Protected Material, (c) inform the person or persons to whom
25 unauthorized disclosures were made of all the terms of this Order, and (d) request such
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1 person or persons to execute the “Acknowledgment and Agreement to Be Bound” that is
2 attached hereto as Exhibit A.
3 11. INADVERTENT PRODUCTION OF PRIVILEGED OR OTHERWISE
4 PROTECTED MATERIAL
5 When a Producing Party gives notice to Receiving Parties that certain inadvertently
6 produced material is subject to a claim of privilege or other protection, the obligations of
7 the Receiving Parties are those set forth in Federal Rule of Civil Procedure 26(b)(5)(B).
8 This provision is not intended to modify whatever procedure may be established in
9 an e-discovery order that provides for production without prior privilege review. Pursuant
10 to Federal Rule of Evidence 502(d) and (e), insofar as the parties reach an agreement on
11 the effect of disclosure of a communication or information covered by the attorney-client
12 privilege or work product protection, the parties may incorporate their agreement in the
13 stipulated protective order submitted to the court.
14 12. MISCELLANEOUS
15 12.1 Right to Further Relief. Nothing in this Order abridges the right of any person
16 to seek its modification by the Court in the future.
17 12.2 Right to Assert Other Objections. By stipulating to the entry of this Protective
18 Order, no Party waives any right it otherwise would have to object to disclosing or
19 producing any information or item on any ground not addressed in this Stipulated
20 Protective Order. Similarly, no Party waives any right to object on any ground to use in
21 evidence of any of the material covered by this Protective Order.
22 12.3 Filing Protected Material. A Party that seeks to file under seal any Protected
23 Material must comply with Local Civil Rule 79-5. Protected Material may only be filed
24 under seal pursuant to a court order authorizing the sealing of the specific Protected
25 Material at issue. If a Party’s request to file Protected Material under seal is denied by the
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1 court, then the Receiving Party may file the information in the public record unless
2 otherwise instructed by the court.
3 12.4 This Stipulation and Protective Order is entered into without prejudice to the
4 right of any Party to knowingly waive the applicability of this Stipulation and Protective
5 Order to any Confidential Materials designated by that Party. If the Designating Party uses
6 Confidential Materials in a non-Confidential manner, then the Designating Party shall
7 advise all parties that the designation no longer applies.
8 12.5 This Stipulation and Protective Order shall be binding on the Parties upon its
9 execution and will govern the production and/or disclosure of Confidential Materials
10 before and/or in the absence of approval by the Court.
11 13. FINAL DISPOSITION
12 After the final disposition of this Action, as defined in paragraph 4, within 60 days
13 of a written request by the Designating Party, each Receiving Party must return all
14 Protected Material to the Producing Party or destroy such material. As used in this
15 subdivision, “all Protected Material” includes all copies, abstracts, compilations,
16 summaries, and any other format reproducing or capturing any of the Protected Material.
17 Whether the Protected Material is returned or destroyed, the Receiving Party must submit
18 a written certification to the Producing Party (and, if not the same person or entity, to the
19 Designating Party) by the 60 day deadline that (1) identifies (by category, where
20 appropriate) all the Protected Material that was returned or destroyed and (2) affirms that
21 the Receiving Party has not retained any copies, abstracts, compilations, summaries or any
22 other format reproducing or capturing any of the Protected Material. Notwithstanding this
23 provision, Counsel are entitled to retain an archival copy of all pleadings, motion papers,
24 trial, deposition, and hearing transcripts, legal memoranda, correspondence, deposition and
25 trial exhibits, expert reports, attorney work product, and consultant and expert work
26 product, even if such materials contain Protected Material. Any such archival copies that
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contain or constitute Protected Material remain subject to this Protective Order as set forth
in
3 14. VIOLATION
4 Any violation of this Order may be punished by appropriate measures including,
without limitation, contempt proceedings and/or monetary sanctions.
6
7
8
9
IS SO STIPULATED, THROUGH COUNSEL OF RECORD.
DATED:
12
13} Attorneys for Plaintiff
14) DATED:
15
16] Attorneys for Defendant
FOR GOOD CAUSE SHOWN, IT IS SO ORDERED.
19/DATED: August 16, 2021
20
21 Pali Dana hug _
HON. PATRICIA DONAHUE
United States Magistrate Judge
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1 EXHIBIT A
2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND
3 I, [print or type full name], of [print
4 or type full address], declare under penalty of perjury that I have read in its entirety and
5 understand the Stipulated Protective Order that was issued by the United States District
6 Court for the Central District of California on [date] in the case of Stephen Cartwright v.
7 Envoy Air, Inc., District Court of California, Central District, Case No. 2:21−cv−05049
8 RGK (PDx). I agree to comply with and to be bound by all the terms of this Stipulated
9 Protective Order and I understand and acknowledge that failure to so comply could expose
10 me to sanctions and punishment in the nature of contempt. I solemnly promise that I will
11 not disclose in any manner any information or item that is subject to this Stipulated
12 Protective Order to any person or entity except in strict compliance with the provisions of
13 this Order. I further agree to submit to the jurisdiction of the United States District Court
14 for the Central District of California for enforcing the terms of this Stipulated Protective
15 Order, even if such enforcement proceedings occur after termination of this action.
16 I hereby appoint [print or type full name] of [print or
17 type full address and telephone number] as my California agent for service of process in
18 connection with this action or any proceedings related to enforcement of this Stipulated
19 Protective Order.
20 Date:
21 City and State where sworn and signed:
22 Printed name:
23 Signature:
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