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Michael A. McGill, SBN 231613 mcgill@policeattorney.com Christopher L. Gaspard, SBN 275763 chris@policeattorney.com Jeremy D. Jass, SBN 279466 jeremy@policeattorney.com LACKIE, DAMMEIER & MCGILL APC 367 North Second Avenue Upland, CA 91786 Telephone: (909) 985-4003 Facsimile: (909) 985-3299 Attorneys for Plaintiff RUDY CAMPOS
UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA

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RUDY CAMPOS, Plaintiff,

vs.

C11 se12 - 050 05Svwt CaNe

vl

CITY OF IRWINDALE, a municipal corporation; MARIO CAMACHO, individually and as Lieutenant for the 22 Irwindale Police Department; and DOES 1 THROUGH 10 INCLUSIVE, 23 Defendants. 24
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COMPLAINT FOR DAMAGES AND INJUNCTIVE RELIEF FOR VIOLATION OF INDIVIDUAL CIVIL RIGHTS AND LIBERTIES [42 U.S.C. 1983] DEMAND FOR JURY TRIAL

PRELIMINARY STATEMENT

1.

This is an action for damages and injunctive relief for personal injury

suffered by the individual plaintiff as a result of the wrongful retaliation for lawful
1
COMPLAINT

exercise of individual civil rights and liberties of free expression and association, labor organizational, social and political activities.
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JURISDICTION AND VENUE

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2. Plaintiff's action is authorized by 42 U.S.C. 1983, which provides for redress for the deprivation under color of state law of rights secured by the Constitution and the laws of the United States. Jurisdiction is conferred on this Court by 28 U.S.C. 1343(3), providing for jurisdiction in this Court of suits authorized by 42 U.S.C. 1983 to redress the deprivation under color of state law of any right, privilege, or immunity secured by the Constitution of the United States, and by 28 U.S.C. 1343(4), providing for the protection of civil rights. This Court has authority to provide declaratory and injunctive relief in this case pursuant to 28 U.S.C. 2201 and 2202. Venue is proper in the Central District of California in that the wrongs alleged herein occurred within the County of Los Angeles, within the Central District.
PARTIES

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Plaintiff RUDY CAMPOS ("Campos") was, at all times relevant to 3. this claim unless otherwise mentioned herein, employed by Defendant City of Irwindale in the capacity of Police Officer within the Irwindale Police Department. Plaintiff's home address is confidential under Penal Code 146(e) and 832.7, and Vehicle Code 1808.4(a)(11). Defendant CITY OF IRWINDALE ("the City") is a duly constituted 4. municipal corporation operating under the laws of the State of California, wholly situated in the County of Los Angeles. The Irwindale Police Department ("the Department") is an operating department of the City. At all times relevant herein for all purposes connected with the management of employment relations matters within the Irwindale Police Department, including promotions, assignments, allocation of overtime, and performance evaluations, the City delegated its final policy-making authority to Lieutenant Mario Camacho. Accordingly, the City
2

COMPLAINT

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adopted and ratified each of their decisions as alleged herein as its own policies, customs, practices or decisions, as if the same had been promulgated directly by the City. Defendant MARIO CAMACHO ("Camacho") is currently the only 5. Lieutenant for the Irwindale Police Department. In doing the things alleged herein, Camacho acted under color of state law, within the course and scope of his employment, and as an official policy-maker for the City. Camacho was vested with policy-making authority over actions such as the ones at issue in this complaint. Specifically, as the second highest sworn officer of the City, Camacho is vested with sole and exclusive policy making authority to appoint members of his Department to certain assignments. Camacho's authority in this regard is the result of a long standing practice and custom of the position of Lieutenant being either vested with or delegated such authority. Defendant DOES 1 THROUGH 10 are not known or identified at this 6. time. On information and belief, Plaintiff alleges that each Doe is in some manner responsible for the wrongs alleged herein, and that each such Defendant advised, encouraged, participated in, ratified, directed, or conspired to do, the wrongful acts alleged herein. When the true names and capacities of said Defendants become known, Plaintiff will seek relief to amend this claim to show their true identities in place of their fictitious names as DOES 1 through 10. Defendants, and each of them, were the agents, employees and 7. servants of every other Defendant. Defendants acted in the course and scope of said agency, service and employment at all relevant times. Defendants and employees of Defendants have discriminated and 8. retaliated against Plaintiff for the lawful exercise of his individual civil rights and liberties of free expression and participation in labor, union, and political activities. Defendants have targeted Plaintiff due to these lawful actions.

3
COMPLAINT

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FACTS COMMON TO ALL COUNTS

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9. Plaintiff began his career as a police officer with the City of Baldwin Park in 1999. While at all times employed by the City of Baldwin Park as a highly decorated police officer, Plaintiff and performed his duties competently and without difficulty 10. Plaintiff was first employed by the City of Irwindale as a police officer in or about July 2007. Up until the allegations that are contained within this claim, Plaintiff enjoyed a positive work performance history. While at all times employed by the Department as a police officer, Plaintiff performed his duties competently and without difficulty. 11. In or about November 2007, Plaintiff was elected to the Irwindale Police Officers Association ("IPOA"). At this time, Defendant Camacho was a detective sergeant as he had not yet been promoted to lieutenant. Although a detective sergeant, Camacho was a high ranking officer in the department, as well as a high ranking board member of the IPOA. 12. On or about July 3, 2008, Plaintiff attended a regular scheduled IPOA meeting. The purpose of the meeting was to vote on the contractual agreement between the IPOA and the City of Irwindale. To the board members' understanding, the vote was supposed to be in favor of accepting the City's counteroffer. During the meeting Camacho expressed concerns that detectives should receive paid compensation from the City for recognized holidays, rather than the offered 130 hours of floating holiday time off. Plaintiff countered Camacho's concerns by stating that members of the Detective Bureau receive a 5% pay increase above patrol personnel, are not scheduled to work weekend shifts, and have all City recognized holidays off with pay. Camacho then made a motion to put the issue to a vote. During the vote, Camacho stood directly across from Plaintiff. When Plaintiff raised his hand to vote against Camacho, Camacho looked directly at Plaintiff and said, "That's the last time you get any overtime
4 COMPLAINT

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from me!" The IPOA board members then voted on whether or not to accept the City's counter offer. When Plaintiff voted in favor of accepting the counter offer Camacho said, "We'll see." 13. On or about July 4, 2008, Plaintiff was completing a report in the Department's report writing room, with two other officers in the room. Camacho walked into the report writing room and asked the other two officers to retrieve l unch from a vendor in the City Park. Camacho then gave the officers money and said that he would pay for their lunch. Camacho then told the officers that he would not pay for Plaintiff's lunch because he voted against Camacho at the IPOA meeting. 14. In or about August of 2008, Officer Greg Gomez called Plaintiff to offer him 10 hours of overtime work for a television show that was being filmed in the City of Irwindale. Plaintiff accepted the overtime shift. Approximately 15 minutes later, Officer Gomez called Plaintiff back to cancel the overtime to Plaintiff. Plaintiff asked why his overtime was being cancelled and Gomez responded that the detectives had complained about Gomez's selection process. Gomez admitted that he was permitted to offer the overtime to anyone, but the Plaintiff was still not given the overtime assignment. Camacho was still Detective Sergeant at this time. 15. In or about October of 2008, Plaintiff had signed up on the overtime request board. Someone had crossed out Plaintiff's name from the overtime request board. No other officer had their name crossed out. 16. In or about November of 2008, Camacho sent an email to all IPOA members regarding Plaintiff's IPOA meeting notes. In the email, Camacho accused Plaintiff of having the tendency to make stuff up and attacked Plaintiff's integrity and credibility.

5 COMPLAINT

1 17. In or about November of 2008, Plaintiff continued to sign up on the 2 overtime request board. Again, someone had crossed out Plaintiff's name from the 3 overtime request board. No other officer had their name crossed out. 4 18. In or about November of 2008, someone had placed an employment 5 application to the Public Defender's Office, a copy of the Department policy on 6 personal appearance, and an article on how to beat an ex-traffic officer's citation 7 inside of Plaintiff's work mailbox. 8 19. On or about December 23, 2008, based on information and belief, 9 Camacho had made comments questioning Plaintiff's integrity during a regular 10 IPOA membership meeting. 20. On or about December 29, 2008, Sergeant Robert Avila informed 11 12 Plaintiff that he would not be permitted to work the overtime shift that he was 13 previously scheduled for. This was approximately 18 hours before the shift was to 14 begin. Plaintiff was told that Camacho and Lieutenant Robert Barnes called Avila 15 into Barnes's office and told Avila to cancel Plaintiff from the overtime shift. 16 21. On or about July 9, 2009, Camacho was promoted to Lieutenant. 17 22. In or about August of 2009, based on information and belief, 18 Camacho was overheard saying that he is "2nd in command" of Department 19 personnel. 23. In or about September 2009, Plaintiff applied for a promotion to 20 21 sergeant and sat for the sergeant's examination. 24. On or about September 10, 2009, Camacho sent Plaintiff an email 22 23 requesting Plaintiff to explain one half hour of overtime Plaintiff submitted for 24 taking the sergeant's examination. Based on information and belief, that was the 25 first time an officer at the Irwindale Police Department was required to justify their 26 overtime request for taking a promotional examination. 25. On or about December 23, 2009, during a regularly scheduled IPOA 27 28 meeting, a member was overheard saying "That's why I don't mess with the bull, I
6 COMPLAINT

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get all the OT I want." It is believed that this statement is referring to Camacho, and that anyone who resists him will not get any overtime assignments. 26. On or about December 24, 2009, Camacho denied Plaintiff's request to attend Crisis Negotiator Training. This denial was sent despite the fact that on December 10, 2009, Camacho had initially told Plaintiff that Camacho would approve the paid training. 27. In or about March 2010, Plaintiff met with Sergeant Avila to review Plaintiff's performance evaluation for the period of 2009. During this meeting, Avila accused Camacho of changing Avila's original comments, ratings, and markings to reflect a poor evaluation of Plaintiff for 2009. Avila told Plaintiff, "It was a lot worse than this. I cleaned it up." Sergeant Avila told Plaintiff that Camacho changed, altered, and made Sergeant Avila issue Plaintiff the evaluation that Camacho had wanted Plaintiff to receive. Sergeant Avila claimed he was just following Camacho's orders by issuing Plaintiff the altered performance evaluation. 28. In or about June 2011, Plaintiff met with Sergeant Luther Ritter to review Plaintiff's performance evaluation. Ritter told Plaintiff that Ritter was issued the evaluation and was told to give it to Plaintiff. Ritter acknowledged that he did not agree with then Chief Hiltz and Lieutenant Camacho's decision or comments, but Ritter explained he had to follow the orders of Hiltz and Camacho. 29. On or about January 27, 2012, Plaintiff met with Sergeant Phil Reeves to complete and review Plaintiff's annual performance evaluation for the period of 2011. Reeves performance evaluation of Plaintiff was very positive. 30. In or about January of 2012, Reeves met with Camacho. During that meeting, based on information and belief, Camacho stated the Plaintiff was a "cancer" on the Department. 31. In or about January of 2012, Reeves submitted Plaintiff's performance evaluation to Camacho.
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COMPLAINT

3 4

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32. In or about January of 2012, subsequent to Reeves submitting Plaintiff's performance evaluation to Camacho, Chief of Police Smith pressured Reeves to change Plaintiff's performance evaluation to reflect a negative rating. Chief Smith directed Reeves to meet with Camacho to alter Plaintiff's performance evaluation. Reeves refused to alter Plaintiff's performance evaluation. 33. On or about March 12, 2012, Sergeant Avila handed Plaintiff a performance evaluation that was completed by Sergeant David Fraijo. The rating period on the evaluation was January 1, 2011 thru December 31, 2011, which was the same period that Sergeant Reeves had previously evaluated Plaintiff. This later performance evaluation reflected a negative rating of Plaintiff's performance.
CLAIMS
42 U.S.C. 1983

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34. Plaintiff hereby incorporates each and every preceding paragraph as though set forth in full here. As a direct result of Plaintiff exercising his First Amendment rights, 35. Defendants took the aforementioned adverse actions against Plaintiff. Absent said protected speech, Plaintiff would not have suffered adverse employment actions, and would not have been injured. At all times mentioned herein, Plaintiff's speech activities were not taken pursuant to his official job duties. 36. The various acts of intimidation, reprisal, retaliation, suppression and/or restraint exercised by Defendants against Plaintiff has created a chilling effect on his legitimate exercise of speech by creating fear, hesitation, hostility and other destructive responses. 37. In doing the things alleged herein, Defendants, and each of them, violated the rights of Plaintiff under the First and Fourteenth Amendments to the United States Constitution to free expression. Specifically, Defendants have taken the aforementioned action against Plaintiff in direct retaliation for, and in response to the protected activities of Plaintiff.
8 COMPLAINT

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38.

The acts and omissions of Defendants, and each of them, were done

by Defendants under color of state law and as policy making authorities to which Defendant City delegated its governing powers in the subject matter areas in which these policies were promulgated or decisions taken or customs and practices followed. The acts and omissions described above were taken by the City's official policy makers as members charged with such responsibility. It was or should have been plainly obvious to any reasonable policy making official of the City that the acts and omissions of Defendants as alleged herein, taking singly or in conjunction directly violated and continued to violate Plaintiff's clearly established constitutional and statutory rights. In doing the things alleged herein, Defendants acted with malicious intent to violate Plaintiff's rights, or at least in conscious, reckless, and callous disregard of Plaintiff's rights and to the injurious consequences likely to result from a violation of said rights. General and special damages are sought according to proof. Punitive damages are sought against the individual defendant, according to proof. 39. Plaintiff has no plain, speedy nor adequate remedy at law to prevent future violations of his civil rights, and therefore seeks extraordinary relief in the form of permanent injunctions, as hereafter described. Damages alone are inadequate and injunctive relief is sought to command Defendants to place Plaintiff in the position he would have been in, absent the unlawful conduct of Defendants.
,

WHEREFORE, Plaintiff prays for:

1. 2. 3. General, compensatory, and special damages according to proof; Punitive damages against the individually named defendants only; Injunctive relief ordering Defendants a) To immediately return Plaintiff to the position he would have been in had he not been subjected to the adverse employment actions;

9 COMPLAINT

b)

To expunge any negative personnel documents provided by Defendants relating to the adverse actions that are the subject of this action; and

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c) 4. 5. 6.
7.

To take any and all necessary and reasonable steps to remove the stigma and negative perception of Plaintiff;

Attorney's fees as permitted by law; Costs of suit; Interest as provided by law; and
Each other and further relief as the Court deems just and proper.

Dated: July 5, 2012

LACKIE, DAMMEIER & MCGILL APC

el A. stopher L. G remy D. Jass Attorneys for P r intiff, RUDY CAMPOS

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10 COMPLAINT

DEMAND FOR JURY TRIAL

Plaintiff hereby demands a jury trial under F.R. Civ. P., Rule 38 and C.D.
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Cal. Rule 3.4.10.1. Dated: July 5, 2012 LACKIE, DAMMEIER & MCGILL APC

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ael A. Gill stopher . Gas remy D. Jass

Attorneys for PhD tiff,

RUDY CAMPOS

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COMPLAINT

UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA

NOTICE OF ASSIGNMENT TO UNITED STATES MAGISTRATE JUDGE FOR DISCOVERY

This case has been assigned to District Judge Stephen V. Wilson and the assigned discovery Magistrate Judge is Michael Wilner. The case number on all documents filed with the Court should read as follows:

CV12

5805 SVW (MRWx)

Pursuant to General Order 05-07 of the United States District Court for the Central District of California, the Magistrate Judge has been designated to hear discovery related motions.

All discovery related motions should be noticed on the calendar of the Magistrate Judge

NOTICE TO COUNSEL

A copy of this notice must be served with the summons and complaint on all defendants (if a removal action is
filed, a copy of this notice must be served on all plaintiffs).

Subsequent documents must be filed at the following location:

[X] Western Division 312 N. Spring St., Rm. G-8 Los Angeles, CA 90012

Southern Division 411 West Fourth St., Rm. 1-053 Santa Ana, CA 92701-4516

Eastern Division 3470 Twelfth St., Rm. 134 Riverside, CA 92501

Failure to file at the proper location will result in your documents being returned to you.

CV-18 (03/06)

NOTICE OF ASSIGNMENT TO UNITED STATES MAGISTRATE JUDGE FOR DISCOVERY

Name & Address: Jeremy Jass, SBN 279466 jeremy@policeattorney.com LACKIE, DAMMEIER & MCGILL, APC 367 North Second Avenue Upland, CA 91786 UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA RUDY CAMPOS
CASE NUMBER

PLAINTIFF(S)

CV12m 05 05;yvvh4v, o)
SUMMONS

v. COUNTY OF IRWINDALE, a municipal corporation; (See Attachment)

DEFENDANT(S).

TO: DEFENDANT(S): City of Irwindale, a municipal corporation, Mario Camacho, individually and as lieutenant for the Irwindale Police Department; and Does 1 Through 10 Inclusive A lawsuit has been filed against you. Within 21 days after service of this summons on you (not counting the day you received it), you must serve on the plaintiff an answer to the attached gcomplaint q amended complaint q counterclaim q cross-claim or a motion under Rule 12 of the Federal Rules of Civil Procedure. The answer , whose address is or motion must be served on the plaintiff's attorney, Jeremy Jass Llackie, Dammeier & McGill, 367 North Second Avenue, Upland, CA 91786 . If you fail to do so, judgment by default will be entered against you for the relief demanded in the complaint. You also must file your answer or motion with the court.

JUL -5 2012
Dated:

Clerk, U.S. District Court

ILL

JULIE PRADO
B:
Deptiliy CSI
(Seal of th

1154
[Use 60 days if the defendant is the United States or a United States agency, or is an officer or employee of the United States. Allowed 60 days by Rule 12(a)(3)].

CV-01A (12/07)

SUMMONS

SUM-200(A)
SHORT TITLE:
CASE NUMBER.

___ Campos v. City of Irwindale, et at

INSTRUCTIONS FOR USE This form may be used as an attachment to any summons if space does not permit the listing of all parties on the summons. If this attachment is used, insert the following statement in the plaintiff or defendant box on the summons: "Additional Parties Attachment form is attached." List additional parties (Check only one box. Use a separate page for each type of party ) Plaintiff Defendant Cross-Complainant Cross-Defendant

MARIO CAMACHO, individually and as Lieutenant for the Irwindale Police Department; and DOES 1 THROUGH 10 INCLUSIVE, Defendants.

Page

of

2
Page 1 of 1

Form Adopted for Mandatory Use Judicial Council of California SUM-200(A) [Rev. January 1, 2007]

ADDITIONAL PARTIES ATTACHMENT

Attachment to Summons
American LegalNet, Inc www.Forms Workflow. corn

UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA

CIVIL COVER SHEET
I (a) PLAINTIFFS (Check box if you are representing yourself q )
RUDY CAMPOS

DEFENDANTS
CITY OF IRWINDALE, a municipal corporation; MARIO CAMACHO, individually and as Lieutenant for the Irwindale Police Department; and DOES 1 THROUGH 10 INCLUSIVE,

(b) Attorneys (Firm Name, Address and Telephone Number. If you are representing
yourself, provide same.) Michael A. McGill, LACKIE, DAMMEIER & MCGILL 367 North Second Avenue, Upland, CA 91786

Attorneys (If Known)

II. BASIS OF JURISDICTION (Place an X in one box only.)

q 1 U.S. Government Plaintiff

III. CITIZENSHIP OF PRINCIPAL PARTIES - For Diversity Cases Only

(Place an X in one box for plaintiff and one for defendant.)

b!f3 Federal Question (U.S.

Government Not a Party) Citizen of This State

PTF DEF 0 1 0 1
02 02

PTF DEF
Incorporated or Principal Place of Business in this State Incorporated and Principal Place of Business in Another State Foreign Nation q 4 q 4

q 2 U.S. Government Defendant

q 4 Diversity (Indicate Citizenship Citizen of Another State of Parties in Item III) Citizen or Subject of a Foreign Country

q 5

q 5

q 3

q 3

q 6

q 6

IV. ORIGIN (Place an X in one box only.)

Gi1 Original Proceeding q 2 Removed from State Court q 3 Remanded from Appellate Court q 4 Reinstated or Reopened q 5 Transferred from another district (specify): q 7 Appeal to District q 6 Multi- District Judge from Magistrate Judge Litigation

V. REQUESTED IN COMPLAINT: JURY DEMAND: GiYes CLASS ACTION under F.R.C.P. 23: q Yes fiNo VI. CAUSE OF ACTION
42 U.S.C. Section 1983

q No (Check 'Yes' only if demanded in complaint.)

q MONEY DEMANDED IN COMPLAINT: $

(Cite the U.S. Civil Statute under which you are filing and write a brief statement of cause. Do not cite jurisdictional statutes unless diversity.)

VII. NATURE OF SUIT (Place an X in one box only.)

OTHER STATUTES q q q q 400 State Reapportionment 410 Antitrust 430 Banks and Banking 450 Commerce/ICC Rates/etc. q 460 Deportation q 470 Racketeer Influenced and Corrupt Organizations q 480 Consumer Credit q 490 Cable/Sat TV q 810 Selective Service q 850 Securities/Commodities/ Exchange q 875 Customer Challenge 12 USC 3410 q 890 Other Statutory Actions q 891 Agricultural Act q 892 Economic Stabilization Act q 893 Environmental Matters q 894 Energy Allocation Act q 895 Freedom of Info. Act q 900 Appeal of Fee Determination Under Equal Access to Justice q 950 Constitutionality of State Statutes q q q q q CONTRACT 110 Insurance 120 Marine 130 Miller Act 140 Negotiable Instrument 150 Recovery of Overpayment & Enforcement of Judgment 151 Medicare Act 152 Recovery of Defaulted Student Loan (Excl. Veterans) 153 Recovery of Overpayment of Veteran's Benefits 160 Stockholders' Suits 190 Other Contract 195 Contract Product Liability 196 Franchise REAL PROPERTY 210 Land Condemnation 220 Foreclosure 230 Rent Lease & Ejectment 240 Torts to Land 245 Tort Product Liability 290 All Other Real Property TORTS PERSONAL INJURY q 310 Airplane q 315 Airplane Product Liability q 320 Assault, Libel & Slander q 330 Fed. Employers' Liability q 340 Marine q 345 Marine Product Liability q 350 Motor Vehicle q 355 Motor Vehicle Product Liability q 360 Other Personal Injury q 362 Personal InjuryMed Malpractice q 365 Personal InjuryProduct Liability q 368 Asbestos Personal Injury Product Liability IMMIGRATION q 462 Naturalization Application q 463 Habeas CorpusAlien Detainee q 465 Other Immigration Actions TORTS PERSONAL PROPERTY q 370 Other Fraud q 371 Truth in Lending q 380 Other Personal Property Damage q 385 Property Damage Product Liability BANKRUPTCY q 422 Appeal 28 USC 158 q 423 Withdrawal 28 USC 157 CIVIL RIGHTS q 441 Voting q 442 Employment q 443 Housing/Accommodations q 444 Welfare q 445 American with Disabilities Employment q 446 American with Disabilities Other 11440 Other Civil Rights PRISONER PETITIONS q 510 Motions to Vacate Sentence Habeas Corpus q 530 General q 535 Death Penalty q 540 Mandamus/ Other q 550 Civil Rights q 555 Prison Condition FORFEITURE / PENALTY q 610 Agriculture q 620 Other Food & Drug q 625 Drug Related Seizure of Property 21 USC 881 q 630 Liquor Laws q 640 R.R. & Truck q 650 Airline Regs q 660 Occupational Safety /Health q 690 Other LABOR q 710 Fair Labor Standards Act q 720 Labor/Mgmt. Relations q 730 Labor/Mgmt. Reporting & Disclosure Act q 740 Railway Labor Act q 790 Other Labor Litigation q 791 Empl. Ret. Inc. Security Act PROPERTY RIGHTS q 820 Copyrights q 830 Patent q 840 Trademark SOCIAL SECURITY q 861 HIA (1395ff) q 862 Black Lung (923) q 863 DIWC/DIWW (405(g)) q 864 SSID Title XVI q 865 RSI (405(g)) FEDERAL TAX SUITS q 870 Taxes (U.S. Plaintiff or Defendant) q 871 IRS-Third Party 26 USC 7609

q q

q q q q q q q q q q

C V 1
FOR OFFICE USE ONLY:
Case Number: CV-71 (05/08)

0

Page 1 of 2

AFTER COMPLETING THE FRONT SIDE OF FORM CV-71, COMPLETE THE INFORMATION REQUESTED BELOW. CIVIL COVER SHEET

UNITED STATES DISTRICT COURT, CENTRAL DISTRICT OF CALIFORNIA

CIVIL COVER SHEET VIII(a). IDENTICAL CASES: Has this action been previously filed in this court and dismissed, remanded or closed? [(No

q Yes q Yes

If yes, list case number(s):

VIII(b). RELATED CASES: Have any cases been previously filed in this court that are related to the present case? WNo

If yes, list case number(s):

Civil cases are deemed related if a previously filed case and the present case:

(Check all boxes that apply)

q A. Arise from the same or closely related transactions, happenings, or events; or q B. Call for determination of the same or substantially related or similar questions of law and fact; or q C. For other reasons would entail substantial duplication of labor if heard by different judges; or q D. Involve the same patent, trademark or copyright, and one of the factors identified above in a, b or c also is present.

IX. VENUE: (When completing the following information, use an additional sheet if necessary.)

(a) List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH named plaintiff resides. q Check here if the government, its agencies or employees is a named plaintiff. If this box is checked, go to item (b). County in this District:* California County outside of this District; State, if other than California; or Foreign Country

Los Angeles County

b) List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH named defendant resides. q Check here if the government, its agencies or employees is a named defendant. If this box is checked, go to item (c). County in this District:* Los Angeles County California County outside of this District; State, if other than California; or Foreign Country

c) List the County in this District; California County outside of this District; State if other than California; or Foreign Country, in which EACH claim arose. Note: In land condemnation cases, use the location of the tract of land inv oked. County in this District:* Los Angeles County

California County outside of this District; State, if other than California; or Foreign Country

* Los Angeles, Orange, San Bernardino, Riverside, Ventura, Santa Barbara, or San Luis Obispo Counties Note: In land condemnation cases, use the location of the tract o f land involved X SIGNATURE OF ATTORNEY (OR PRO PER): Notice to Counsel/Parties: The CV-71 (JSor other papers as required by law. This fo but is used by the Clerk of the Court for the
Date July

5, 2012

vil Cover Sheet and t ormation contained herein neither replace nor supplement the filing and service of pleadings oved by the Judicial C erence of the United States in September 1974, is required pursuant to Local Rule 3-1 is not filed se of statistics, venue d initiating the civil docket sheet. (For more detailed instructions, see separate instructions sheet.)

Key to Statistical codes relating to Social Security Cases:

Nature of Suit Code Abbreviation Substantive Statement of Cause of Action

861

HIA

All claims for health insurance benefits (Medicare) under Title 18, Part A, of the Social Security Act, as amended. Also, include claims by hospitals, skilled nursing facilities, etc., for certification as providers of services under the program. (42 U.S.C. 1935FF(b)) All claims for "Black Lung" benefits under Title 4, Part B, of the Federal Coal Mine Health and Safety Act of 1969. (30 U.S.C. 923) All claims filed by insured workers for disability insurance benefits under Title 2 of the Social Security Act, as amended; plus all claims filed for child's insurance benefits based on disability. (42 U.S.C. 405(g)) All claims filed for widows or widowers insurance benefits based on disability under Title 2 of the Social Security Act, as amended. (42 U.S.C. 405(g)) All claims for supplemental security income payments based upon disability filed under Title 16 of the Social Security Act, as amended. All claims for retirement (old age) and survivors benefits under Title 2 of the Social Security Act, as amended. (42 U.S.C. (g))

862
863

BL DIWC DIWW SSID RSI

863

864

865

CV-71 (05/08)

CIVIL COVER SHEET

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