Brandon Pernell v. City of Los Angeles

United States District Court for the Central District of California

Brandon Pernell v. City of Los Angeles

Trial Court Opinion

Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 1 of 15 Page ID #:299

1 Kevin S. Conlogue, SBN 285277 2 ([email protected]) Ashley M. Conlogue, SBN 292083 3 ([email protected]) 4 THE LAW OFFICE OF KEVIN S. CONLOGUE 292 S. La Cienega Blvd., Ste. 207 5 Beverly Hills, CA 90211 6 Tel: (213) 255-8837 Fax: (213) 477-2069 7

8 Attorney for Plaintiffs BRANDON PERNELL & KARLY BROWN 9 10 11 UNITED STATES DISTRICT COURT 12 CENTRAL DISTRICT OF CALIFORNIA 13 BRANDON PERNELL; KARLY Case No. 2:22-cv-00157-DMG-JPR 14 BROWN, [Complaint Filed: January 7, 2022]

15

Plaintiffs, STIPULATED PROTECTIVE 16 ORDER v. 17

18 CITY OF LOS ANGELES; SGT. LOPEZ Trial Date: February 21, 2023 #36501; UNIDENTIFIED LAPD 19 OFFICERS; DEFENSE INTERNATIONAL CORPORATION; 20 and, GREYSTAR CALIFORNIA, INC., 21

Defendants. 22

23 1. INTRODUCTION 24 1.1 PURPOSES AND LIMITATIONS 25 Discovery in this action may involve production of confidential, proprietary, 26 or private information for which special protection from public disclosure and from 27 use for any purpose other than prosecuting this litigation may be warranted. 28 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 2 of 15 Page ID #:300

1 Accordingly, the Parties hereby stipulate to and petition the Court to enter the 2 following Stipulated Protective Order. The Parties acknowledge that this Order 3 does not confer blanket protections on all disclosures or responses to discovery and 4 that the protection it affords from public disclosure and use extends only to the 5 limited information or items that are entitled to confidential treatment under the 6 applicable legal principles. The Parties further acknowledge, as set forth in Section 7 12.3 below, that this Order does not entitle them to file Confidential Information 8 under seal; Civil Local Rule 79-5 sets forth the procedures that must be followed 9 and the standards that will be applied when a Party seeks permission from the Court 10 to file material under seal. 11 1.2 GOOD CAUSE STATEMENT 12 This case arises from allegations that during the late evening of April 25, 2021, 13 members of the Los Angeles Police Department (LAPD) entered the lobby of Circa, 14 a residential apartment complex in downtown Los Angeles, under color of law, and 15 were allowed access to the 23rd Floor, where Plaintiffs Brandon Pernell (African 16 American) and Karly Brown (Asian American) resided in Unit 2324. Plaintiffs’ 17 allege that they were unlawfully detained, arrested and subject to Upon arriving on 18 the 23rd floor, the LAPD proceeded to Plaintiffs’ unit and handcuffed and detained 19 them. Per the Complaint, after thirty minutes, the LAPD unhandcuffed and released 20 Plaintiffs. At no time did the LAPD offer any explanation for detaining Plaintiffs. 21 Plaintiffs allege that the LAPD’s actions were racially motivated and not based on 22 any legal grounds. 23 In addition to the City of Los Angeles, Plaintiffs have name Defense 24 International Corporation, which provided security services at Circa, and Greystar 25 California, the Circa property manager, as Defendants. As against Defense 26 International Corporation and Greystar California, Plaintiffs’ Complaint alleges 27 causes of action for Unreasonable Search and Seizure – Unlawful Entry, Detention 28 and Arrest; Unreasonable Search and Seizure – Excessive Force; Conspiracy to 2 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 3 of 15 Page ID #:301

1 Violate Civil Rights; Negligence; Assault and Battery; Trespass; Invasion of 2 Privacy; Bane Act (CA Civil Code § 52.1); and Ralph Act (CA Civil Code § 51.7). 3 In addition to these causes of action, Plaintiffs also allege a Monell claim against the 4 City of Los Angeles. 5 In furtherance of their claims, discovery and information will be exchanged 6 that is subject to a Protective Order. This discovery includes the following: 7 (1) Complete administrative, criminal and personnel complaint 8 investigations pertaining to the LAPD officers that responded to Plaintiffs’ 9 unit; (2) Complete City of Los Angeles Police Department's Internal 10 11 Investigations file concerning its investigation into all personnel complaints 12 made by or on behalf of Plaintiffs; 13 (3) Proprietary, trade secret and/or commercially sensitive information 14 15 detailing contractual agreements by Defense International and Greystar 16 California with respect to the subject residential premises, Circa. 17 Dissemination of these agreements could adversely affect the parties 18 19 competitive positions and/or business operations. 20 (4) Documents and information pertaining to the security arrangements for 21 Circa, a 648 unit residential property in downtown Los Angeles, California. 22 23 Dissemination of these agreements could potentially impact the resident 24 safety and adversely affect the parties competitive positions and/or business 25 operations, and also 26 27 28 3 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 4 of 15 Page ID #:302

(5) Complete copies of each writing, record or document identified in 1 2 Defendants' Initial Disclosures. 3 (6) Plaintiffs’ medical, mental health and employment records. 4 2. DEFINITIONS 5 6 2.1 Action: This pending action, Brandon Pernell v. City of Los Angeles, 7 Case Number 2:22-cv-00157-DMG-JPR 8 9 2.2 Challenging Party: a Party or Nonparty that challenges the designation 10 of information or items under this Order. 11 2.3 “CONFIDENTIAL” Information or Items: information (regardless of 12 how it is generated, stored, or maintained) or tangible things that qualify for 13 protection under Federal Rule of Civil Procedure 26(c) and as specified above in the 14 Good Cause Statement. 15 2.4 Counsel: Outside Counsel of Record and House Counsel (as well as 16 their support staff). 17 2.5 Designating Party: a Party or Nonparty that designates information or 18 items that it produces in disclosures or in responses to discovery as 19 “CONFIDENTIAL.” 20 2.6 Disclosure or Discovery Material: all items or information, regardless 21 of the medium or manner in which it is generated, stored, or maintained (including, 22 among other things, testimony, transcripts, and tangible things), that are produced or 23 generated in disclosures or responses to discovery in this matter. 24 2.7 Expert: a person with specialized knowledge or experience in a matter 25 pertinent to the litigation who has been retained by a Party or its counsel to serve as 26 an expert witness or as a consultant in this action. 27 28 4 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 5 of 15 Page ID #:303

1 2.8 House Counsel: attorneys who are employees of a Party to this Action. 2 House Counsel does not include Outside Counsel of Record or any other outside 3 counsel. 4 2.9 Nonparty: any natural person, partnership, corporation, association, or 5 other legal entity not named as a Party to this action. 6 2.10 Outside Counsel of Record: attorneys who are not employees of a 7 Party to this Action but are retained to represent or advise a Party and have appeared 8 in this Action on behalf of that Party or are affiliated with a law firm that has 9 appeared on behalf of that Party, including support staff. 10 2.11 Party: any Party to this Action, including all of its officers, directors, 11 employees, consultants, retained experts, and Outside Counsel of Record (and their 12 support staffs). 13 2.12 Producing Party: a Party or Nonparty that produces Disclosure or 14 Discovery Material in this Action. 15 2.13 Professional Vendors: persons or entities that provide litigation 16 support services (for example, photocopying, videotaping, translating, preparing 17 exhibits or demonstrations, and organizing, storing, or retrieving data in any form or 18 medium) and their employees and subcontractors. 19 2.14 Protected Material: any Disclosure or Discovery Material that is 20 designated as “CONFIDENTIAL.” 21 2.15 Receiving Party: a Party that receives Disclosure or Discovery 22 Material from a Producing Party. 23 3. SCOPE 24 The protections conferred by this Stipulation and Order cover not only 25 Protected Material (as defined above) but also any information copied or extracted 26 from Protected Material; all copies, excerpts, summaries, or compilations of 27 Protected Material; and any testimony, conversations, or presentations by Parties or 28 their Counsel that might reveal Protected Material. 5 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 6 of 15 Page ID #:304

1 Any use of Protected Material at trial will be governed by the orders of the 2 trial judge. This Order does not govern the use of Protected Material at trial. 3 4. DURATION 4 Once a case proceeds to trial, all the information that was designated as 5 confidential or maintained under this Order becomes public and will be 6 presumptively available to all members of the public, including the press, unless the 7 trial judge finds compelling reasons to proceed otherwise. See Kamakana v. City & 8 Cnty. of Honolulu,

447 F.3d 1172

, 1180-81 (9th Cir. 2006) (distinguishing “good 9 cause” showing for sealing documents produced in discovery from “compelling 10 reasons” needed for merits-related documents). Accordingly, the terms of this 11 Order do not extend beyond the beginning of trial. 12 5. DESIGNATING PROTECTED MATERIAL 13 5.1 Each Party or Nonparty that designates information or items for 14 protection under this Order must take care to limit any such designation to specific 15 material that qualifies under the appropriate standards. The Designating Party must 16 designate for protection only those parts of material, documents, items, or oral or 17 written communications that qualify so that other portions of the material, 18 documents, items, or communications for which protection is not warranted are not 19 swept unjustifiably within the ambit of this Order. 20 Mass, indiscriminate, or routinized designations are prohibited. Designations 21 that are shown to be clearly unjustified or that have been made for an improper 22 purpose (for example, to unnecessarily encumber the case-development process or 23 to impose unnecessary expenses and burdens on other parties) may expose the 24 Designating Party to sanctions. 25 If it comes to a Designating Party’s attention that information or items it 26 designated for protection do not qualify for that level of protection, that Designating 27 Party must promptly notify all other Parties that it is withdrawing the inapplicable 28 designation. 6 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 7 of 15 Page ID #:305

1 5.2 Except as otherwise provided in this Order, Disclosure or Discovery 2 Material that qualifies for protection under this Order must be clearly so designated 3 before the material is disclosed or produced. 4 Designation in conformity with this Order requires the following: 5 (a) for information in documentary form (for example, paper or electronic 6 documents but excluding transcripts of depositions or other pretrial or trial 7 proceedings), the Producing Party must affix at a minimum the legend 8 “CONFIDENTIAL” to each page that contains Protected Material. If only a portion 9 or portions of the material on a page qualify for protection, the Producing Party 10 must clearly identify the protected portion(s) (for example, by making appropriate 11 markings in the margins). 12 A Party or Nonparty that makes original documents available for inspection 13 need not designate them for protection until after the inspecting Party has indicated 14 which documents it would like copied and produced. During the inspection and 15 before the designation, all material made available for inspection must be treated as 16 “CONFIDENTIAL.” After the inspecting Party has identified the documents it 17 wants copied and produced, the Producing Party must determine which documents, 18 or portions thereof, qualify for protection under this Order. Then, before producing 19 the specified documents, the Producing Party must affix the “CONFIDENTIAL” 20 legend to each page that contains Protected Material. If only a portion or portions of 21 the material on a page qualify for protection, the Producing Party also must clearly 22 identify the protected portion(s) (for example, by making appropriate markings in 23 the margins). 24 (b) for testimony given in depositions, the Designating Party must identify 25 the Disclosure or Discovery Material that is protected on the record, before the close 26 of the deposition. 27 (c) for information produced in some form other than documentary and for 28 any other tangible items, the Producing Party must affix in a prominent place on the 7 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 8 of 15 Page ID #:306

1 exterior of the container or containers in which the information is stored the legend 2 “CONFIDENTIAL.” If only a portion or portions of the information warrant 3 protection, the Producing Party, to the extent practicable, must identify the protected 4 portion(s). 5 5.3 If timely corrected, an inadvertent failure to designate qualified 6 information or items does not, standing alone, waive the Designating Party’s right to 7 secure protection under this Order for that material. On timely correction of a 8 designation, the Receiving Party must make reasonable efforts to assure that the 9 material is treated in accordance with the provisions of this Order. 10 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS 11 6.1 Any Party or Nonparty may challenge a designation of confidentiality 12 at any time consistent with the Court’s scheduling order. 13 6.2 The Challenging Party must initiate the dispute-resolution process (and, 14 if necessary, file a discovery motion) under Local Rule 37. 15 6.3 The burden of persuasion in any such proceeding is on the Designating 16 Party. Frivolous challenges, and those made for an improper purpose (for example, 17 to harass or impose unnecessary expenses and burdens on other parties), may expose 18 the Challenging Party to sanctions. Unless the Designating Party has waived or 19 withdrawn the confidentiality designation, all parties must continue to afford the 20 material in question the level of protection to which it is entitled under the 21 Producing Party’s designation until the Court rules on the challenge. 22 7. ACCESS TO AND USE OF PROTECTED MATERIAL 23 7.1 A Receiving Party may use Protected Material that is disclosed or 24 produced by another Party or by a Nonparty in connection with this Action only for 25 prosecuting, defending, or attempting to settle this Action. Such Protected Material 26 may be disclosed only to the categories of people and under the conditions described 27 in this Order. When the Action has been terminated, a Receiving Party must comply 28 with the provisions of Section 13 below (FINAL DISPOSITION). 8 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 9 of 15 Page ID #:307

1 Protected Material must be stored and maintained by a Receiving Party at a 2 location and in a manner sufficiently secure to ensure that access is limited to the 3 people authorized under this Order. 4 7.2 Unless otherwise ordered by the Court or permitted in writing by the 5 Designating Party, a Receiving Party may disclose any information or item 6 designated “CONFIDENTIAL” only to the following people: 7 (a) the Receiving Party’s Outside Counsel of Record in this Action, as 8 well as employees of that Outside Counsel of Record to whom it is reasonably 9 necessary to disclose the information for this Action; 10 (b) the officers, directors, and employees (including House Counsel) of 11 the Receiving Party to whom disclosure is reasonably necessary for this Action; 12 (c) Experts (as defined in this Order) of the Receiving Party to whom 13 disclosure is reasonably necessary for this Action and who have signed the 14 “Acknowledgment and Agreement to Be Bound” (Exhibit A); 15 (d) the Court and its personnel; 16 (e) court reporters and their staff; 17 (f) professional jury or trial consultants, mock jurors, and Professional 18 Vendors to whom disclosure is reasonably necessary for this Action and who have 19 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 20 (g) the author or recipient of a document containing the information or a 21 custodian or other person who otherwise possessed or knew the information; 22 (h) during their depositions, witnesses and attorneys for witnesses to 23 whom disclosure is reasonably necessary, provided that the deposing party requests 24 that the witness sign the form attached as Exhibit A hereto and the witnesses will 25 not be permitted to keep any confidential information unless they sign the form, 26 unless otherwise agreed by the Designating Party or ordered by the Court. Pages of 27 transcribed deposition testimony or exhibits to depositions that reveal Protected 28 9 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 10 of 15 Page ID #:308

1 Material may be separately bound by the court reporter and may not be disclosed to 2 anyone except as permitted under this Order; and 3 (i) any mediator or settlement officer, and their supporting personnel, 4 mutually agreed on by any of the Parties engaged in settlement discussions or 5 appointed by the Court. 6 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED 7 PRODUCED 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,” 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” before a determination on the protective-order request 22 by the relevant court unless the Party has obtained the Designating Party’s 23 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 28 10 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 11 of 15 Page ID #:309

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.” Such information is 5 protected by the remedies and relief provided by this Order. Nothing in these 6 provisions should be construed as prohibiting a Nonparty from seeking additional 7 protections. 8 (b) In the event that a Party is required by a valid discovery request to 9 produce a Nonparty’s Confidential Information in its possession and the Party is 10 subject to an agreement with the Nonparty not to produce the Nonparty’s 11 Confidential 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 Information responsive to the discovery 23 request. If the Nonparty timely seeks a protective order, the Receiving Party must 24 not produce any information in its possession or control that is subject to the 25 confidentiality agreement with the Nonparty before a ruling on the protective-order 26 request. Absent a court order to the contrary, the Nonparty must bear the burden 27 and expense of seeking protection of its Protected Material. 28 11 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 12 of 15 Page ID #:310

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 12 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). 16 12. MISCELLANEOUS 17 12.1 Nothing in this Order abridges the right of any person to seek its 18 modification by the Court. 19 12.2 By stipulating to the entry of this Order, no Party waives any right it 20 otherwise would have to object to disclosing or producing any information or item 21 on any ground not addressed in this Order. Similarly, no Party waives any right to 22 object on any ground to use in evidence of any of the material covered by this 23 Order. 24 12.3 A Party that seeks to file under seal any Protected Material must 25 comply with Civil Local Rule 79-5. Protected Material may be filed under seal only 26 pursuant to a court order authorizing the sealing of the specific Protected Material at 27 issue. If a Party's request to file Protected Material under seal is denied, then the 28 12 Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 13 of 15 Page ID #:311

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 28 13 Case 4/22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 14o0f15 Page ID #:312

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. 6 IT IS SO STIPULATED, THROUGH COUNSEL OF RECORD. 8 DATED: May 9, 2022 /s/ Ashley M. Conlogue 9 Kevin S. Conlogue Ashley M. Conlogue 10 Attorney for Plaintiffs 1] 12 || DATED: May 9, 2022 /s/ William R. Johnson 13 William R. Johnson Emily Berman 14 Attorneys for Defendant, Greystar California, Inc. 15 16 DATED: May 9, 2022 /s/ Alison K. Hurley __ 17 Alison K. Hurley Attorneys for Defendant, Defense International 18 Corporation 19 0 DATED: May 9, 2022 _____s/s/ Geoffrey Plowden Geoffrey Plowden 71 Attorneys for Defendant, City of Los Angeles 22 53 PURSUANT TO STIPULATION, IT IS SO ORDERED.

24 fe brehodtl~ 25 || DATED: May 12, 2022 Jean P. Rosenbluth 26 U.S. Magistrate Judge 27 28 14

Case 2:22-cv-00157-DMG-JPR Document 55 Filed 05/12/22 Page 15 of 15 Page ID #:313

1 EXHIBIT A 2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND 3 I, _____________________________ [print or type full name], of _________________ [print or 4 5 type full address], declare under penalty of perjury that I have read in its entirety and understand the 6 Stipulated Protective Order that was issued by the United States District Court for the Central 7 District of California on ________, 2022, in the case of Pernell, et al. v. City of Los Angeles, et al. 8 (Case No. 2:22-cv-00157-DMG-(JPR). I agree to follow and to be bound by all the terms of this 9 Stipulated Protective Order and I understand and acknowledge that failure to so comply could 10 expose me to sanctions and punishment in the nature of contempt. I solemnly promise that I will not 11 disclose in any manner any information or item that is subject to this Stipulated Protective Order to 12 13 any person or entity except in strict compliance with the provisions of this Order. 14 I further agree to submit to the jurisdiction of the United States District Court for the Central 15 District of California for the purpose of enforcing the terms of this Stipulated Protective Order, even 16 if such enforcement proceedings occur after termination of this action. 17 I hereby appoint __________________________ [print or type full name] of 18 _______________________________________ [print or type full address and telephone number] 19 as my California agent for service of process in connection with this action or any proceedings 20 21 related to enforcement of this Stipulated Protective Order. 22 Date: ________________________ 23 City and State where sworn and signed: _________________________________ 24

25 Printed name: _______________________________ 26

27 28 Signature: __________________________________ 15

Reference

Status
Unknown