Confidential Cover Sheet False Claims Action {CM-011}

Form Adopted for Mandatory Use Judicial Council of California CM-011 [Rev. September 1, 2018]CONFIDENTIAL COVER SHEET FALSE CLAIMS ACTIONGov. Code, 247 12652(c) Cal. Rules of Court, rules 2.570-2.573 www.courts.ca.govPage 1 of 1CM-011 ATTORNEY OR PARTY WITHOUT ATTORNEYSTATE BAR NUMBER:NAME:FIRM NAME:STREET ADDRESS:CITY:STATE:ZIP CODE:TELEPHONE NO.:FAX NO.:E-MAIL ADDRESS:ATTORNEY FOR:PLAINTIFFOTHER (SPECIFY): SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME: [UNDER SEALl][UNDER SEALl]PlaintiffDefendant CONFIDENTIAL COVER SHEET226FALSE CLAIMS ACTION FOR COURT USE ONLY CASE NUMBER:CONFIDENTIALDate: INSTRUCTIONS: This civil action is brought under the False Claims Act, Government Code section 12650 et seq. The documents filed in this case are under seal and are confidential pursuant to Government Code section 12652(c).UNLESS: (1) Motion to extend time is pending; or (2) Extended by court orderThis Confidential Cover Sheet must be affixed to the caption page of the complaint and to any other paper filed in this case until the seal is lifted.You should check with the court to determine whether papers filed in False Claims Act cases must be filed at a particular location.The document to which this cover sheet is affixed is:a.b.c.d.e.f.g.h.This Confidential Cover Sheet and the attached document must each be separately file-stamped by the clerk of the court.Complaint for damages for violation of the False Claims ActSeal to expire on (date):Civil Case Cover Sheet (form 982.2(b)(1))Motion for an extension of time to interveneAffidavit or other document in support of the motion for an extension of timeOrder extending time to intervene (specify date order expires):Other order (describe):Notice from the Attorney General of additional prosecuting authority that may have access to the fileOther(describe):1. 2. American LegalNet, Inc.