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Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 1 of 16









UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA

In re: Oil Spill by the Oil Rig

"Deepwater Horizon" in the Gulf
of Mexico, on April 20, 2010

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*
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Applies to: All Cases
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* * * * * * * * * * * *









MDL No. 2179; CA 10-2771

SECTION: J

JUDGE BARBIER

MAGISTRATE SHUSHAN

PRE-TRIAL ORDER NO. 25

[Clarifying the Pleading Bundles, Responsive Pleadings, and the Master Complaints]


At the suggestion and stipulation of Plaintiffs, by and through Plaintiffs' Liaison Counsel

and the Plaintiffs Steering Committee, and of Defendants, by and through Defense Liaison

Counsel,1 in order to clarify Case Management Order No. 1 [PTO No. 11], and to facilitate the

efficient and effective management and prosecution of the coordinated actions herein:

IT IS ORDERED that the scope and effect of the "B1" BUNDLE MASTER COMPLAINT [Doc

879], the "B3" BUNDLE MASTER COMPLAINT [Doc 881], and the "D1" BUNDLE MASTER

COMPLAINT [Doc 880], (collectively referred to herein as "Master Complaints"), are hereby

clarified as follows:


1 The Court notes that Defendant Nalco objects to paragraph 4 of this Pre-Trial Order.




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1. Pleading Bundle B3, as described in Section III(B) of CMO No. 1 [PTO 11], is

clarified as follows: “Clean-Up, Medical Monitoring, and Post-April 20 Personal Injury

Claims. This pleading bundle will include all claims, of any type, relating to post-explosion

clean-up efforts asserted against Defendants not named in the B1 Master Complaint, as well as

all claims for personal injury and/or medical monitoring for exposure or other injury occurring

after the explosion and fire of April 20, 2010. The Pleading Bundles described in the CMO and

further herein have been created for administrative purposes, and a plaintiff is accordingly

permitted to assert claims within both Pleading Bundle B1 and Pleading Bundle B3 without

being deemed to have “split” his or her cause of action.

2. For the purpose of clarifying the defendants’ obligations to provide responsive

pleadings under the CMO, the cases identified in EXHIBIT 1 shall be deemed to comprise all

cases currently pending in the MDL that fall within Pleading Bundle A as defined in PTO No.

11, and the cases identified in EXHIBIT 2 shall be deemed to comprise all cases currently pending

in the MDL that fall within Pleading Bundle C as defined in PTO No. 11.

3. Any case currently pending in the MDL that does not fall within Pleading Bundles A

or C is deemed to fall within one or more of the following: Pleading Bundle B1, Pleading

Bundle B3, and/or Pleading Bundle D1, as may be applicable.

4. Any individual plaintiff who is a named plaintiff in a case that falls within Pleading

Bundle B1, B3, D1, or D2, or any combination thereof, is deemed to be a plaintiff in the

applicable Master Complaint(s). Plaintiffs Liaison Counsel shall provide to Defense Liaison





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Counsel a list of plaintiffs included in these bundles within a time period to be agreed to between

Liaison Counsel.

5. For the procedural and administrative purpose of answering or otherwise responding

to the complaints in Pleading Bundles B1, B3 and D1, (and subject to the provisions of

Paragraph 8), as to any Defendant named in one or more Master Complaint(s), the allegations,

claims, theories of recovery and/or prayers for relief contained within the pre-existing petition or

complaint are deemed to be amended, restated, and superseded by the allegations, claims,

theories of recovery, and/or prayers for relief in the respective Master Complaint(s) in which the

Defendant is named that apply to the pre-existing petition or complaint.

6. Subject to the provisions of Paragraph 8, any plaintiff-specific allegations or lack

thereof in an individual petition or complaint covered by a Master Complaint - such as

allegations concerning a plaintiff's domicile and/or residence, whether plaintiff filed an OPA

claim with BP and/or the Gulf Coast Claims Facility, the location and type of real or movable

property at issue, plaintiff's occupation or type of business and allegations of damages and/or

injuries, if any, as asserted by that plaintiff in his individual petition or complaint - may be cited

for illustrative purposes by any defendant in any motion to dismiss the relevant Master

Complaint.

7. As to those cases which are allocated to Pleading Bundle A or C, the 30 day deadline

for any defendant to file any responsive pleadings will not begin to run until the later of (a) the

date such complaint or petition is served upon a defendant or (b) the date classification of such





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complaint into its appropriate pleading bundle(s) occurs. Nothing in this paragraph shall

preclude the parties from seeking the Court's approval to extend the 30 day deadline for a

defendant to file a responsive pleading to any case which is allocated to Pleading Bundle A or C.

8. All individual petitions or complaints that fall within Pleading Bundles B1, B3, D1, or

D2, whether pre-existing or filed hereafter, are stayed until further order of the Court.

9. Whether through counsel or pro se, any individual or entity who heretofore has not

filed a complaint, petition or claim in limitation arising out of the Deepwater Horizon oil spill

and who desires to bring a claim in Limitation [No. 10-2771] and/or assert a cause of action

subject to one or more of the Master Complaints, [Doc 879 and/or 881], may do so by filing

directly into Civil Action No. 10-8888 the form reflected in EXHIBIT 3 [“short form”] or other

form prepared and supplied by the Plaintiffs' Steering Committee and approved by the Court.

The filing of a short form in Civil Action No. 10-8888 shall be deemed to be a simultaneous

filing of an answer and claim in Civil Action No. 10-2771 and an intervention into one or more

of the Master Complaints [Doc 879 and/or 881] in Civil Action No. 10-md-2179. The filing of

short form joinders shall be fully subject to the provisions of PTO No. 20, addressing Direct

Filing.

10. Subject to the provisions of Paragraph 15 and the Direct Filing Order [PTO No. 20],

the filing of the Master Complaints shall not waive any contentions relating to venue,

jurisdiction, or choice of law, all of which are specifically preserved.

11. The filing of the Master Complaints shall not be deemed to waive or supersede

requests for the certification of one or more class actions (and/or sub-classes) under Rule 23,





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(which proceedings are currently stayed pursuant to Paragraph VII of CMO No.1 [PTO No. 11]),

except to the extent that such proposed class definitions and/or allegations are covered in one or

more of the Master Complaints, which are hereby deemed to be the operative complaints with

respect to same.

12. Defendants who have been properly served with the applicable Master Complaint(s)

or have agreed to accept or waive such service of process shall have 30 days from the date of this

Order to file any responsive pleadings referenced in Paragraph IV(B) of CMO No. 1 [PTO No.

11]. Likewise, Defendants who have been properly served with any Bundle A individual

complaint listed on Exhibit 1 shall have 30 days from the date of this Order to file any responsive

pleadings referenced in Paragraph IV(B) of CMO No. 1 [PTO No. 11]. Defendants who have

not been properly served with the applicable Master Complaint(s) and who have not agreed to

accept or waive such service of process shall have 30 days from the date of proper service to file

any responsive pleadings referenced in Paragraph IVB of the CMO. Consistent with the CMO,

Memoranda in Opposition to any Rule 12(b)(1), 12(b)(6), or 12(c) motions shall be filed within

30 days of the filing of said motion. Any Reply Briefs shall be filed within 30 days of the filing

of any Memoranda in Opposition. The page limitation for responsive motions and oppositions to

responsive motions shall be set at 50 pages, and the page limitation for replies to oppositions

shall be set at 25 pages.

13. The proper service of any Master Complaint as to any Defendant named therein shall

constitute service on behalf of all plaintiffs who are deemed to be plaintiffs in the respective

Master Complaints as contemplated in Paragraph 4 of this Order.





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14. Plaintiffs in a pre-existing petition or complaint are not required to file a short form

joinder but should they desire to adopt the short form joinder for the purposes of making a claim

in the Limitation proceeding [No. 10-2771], they may file with the Court and serve upon counsel

through LNFS a short form joinder consistent with the deadlines already established for the

submission of claims in Limitation.

15. In answering or otherwise responding to each Master Complaint, no defenses,

objections, motions or exceptions for lack of jurisdiction, lack of presentment, mootness, lack of

standing, or any other defense that may be specific or unique to any particular plaintiff shall be

waived, and all such defenses, objections, motions and/or exceptions specific to any particular

plaintiff shall be reserved. In addition, any and all rights under the Hague Convention shall not

be deemed to be waived by the entry of this Order, and are hereby preserved.

16. With respect to any new petition or complaint that is filed in or transferred to MDL

No. 2179, the old Plaintiff Fact Sheet [Doc 642-1] is hereby replaced with the Plaintiff Profile

Form attached as EXHIBIT 4. Consistent with the Order Regarding Plaintiff Profile Form [Doc

642], any plaintiff who does not file a short-form joinder [EXHIBIT 3] must serve via LNFS a

completed Plaintiff Profile Form as reflected in EXHIBIT 4 within sixty (60) days of transfer to,

removal to or filing in the Eastern District of Louisiana. However, a plaintiff who files a short-

form joinder does not have to also serve a PPF.

17. The phrase ‘substantially similar’ as used in Paragraph 9 of this Order shall mean all

of the data fields of the attached approved Short Form. That is, without further order of the

Court, the Short Form can be refined in terms of paper or form size, type size, fonts, graphics, etc





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Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 7 of 16





(so long as it contains all the data fields approved in the attached) to make it clearer, more user-

friendly, less expensive to mail or administer, etc. 

18. Paragraph 18 of the "B3" Bundle Master Complaint [Doc 881] is amended to delete

the second sentence of the paragraph in its entirety, such that only the factual allegations of the

B1 Master Complaint are incorporated into and made a part of the B3 Master Complaint, but not

any causes of action. Likewise, Paragraph 55 of the "D1" BUNDLE MASTER COMPLAINT [Doc

880] is clarified to mean that only the factual allegations of the B1 Master Complaint are

incorporated into and made a part of the D1 Master Complaint, but not any causes of action.

19. No provision of this Stipulated Order shall be construed to permit the assertion of

any class actions or class claims as part of the Master Claim in Limitation [No. 10-2771] or

otherwise as part of the Limitation Action [No. 10-2771].



SIGNED this ___ day of -------------,, 2011, in New Orleans, Louisiana.




Hon. Carl J. Barbier
U.S. District Court Judge


D 1607437 v1-24010/0002 PLEADINGS




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New Orleans, Louisiana this 12th day of January, 2011.UnitedStatesDistrictJudgeCase 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 8 of 16



MDL 2179

In Re: Oil Spill by Deepwater Horizon

Pleading Bundle A Cases

*List comports with BP and Anadarko lists.

Plaintiff
Last Name

Plaintiff
First Name Case Caption

EDLA Docket

Filing Attorney

Becnel

Melinda

Melinda Becnel v. BP, PLC

2:10-cv-3066

Benton

Oleander

Oleander Benton v. Transocean, Ltd.

2:10-cv-4226

Crawford

Douglas

Douglas Crawford v. BP, PLC

2:10-cv-1540

James C. Klick
(Herman, Herman, Katz &
Cotlar)

Anthony G. Buzbee
(The Buzbee Law Firm)

Gerald E. Meunier
(Gainsburgh, Benjamin,
David, Meunier &
Warshauer)

Davis

Matthew

Matthew Davis v. Cameron International
Corporation

2:10-cv-3169

Anthony G. Buzbee
(The Buzbee Law Firm)

Faulk

Shane

Shane Faulk v. Transocean, Ltd.

2:10-cv-4227

John

Lance

Lance John v. Transocean, Ltd.

2:10-cv-4229

Johnson

Elton

Elton Johnson v. BP, PLC

2:10-cv-1674

Jones

Michelle

Michelle Jones v. Transocean, Ltd.

,

2:10-cv-1196

Jones

Brad

Brad Jones v. Cameron International
Corporation

2:10-cv-3184

Kleppinger

Tracy

Tracy Kleppinger v. Transocean
Offshore Deepwater Drilling, Inc.

2:10-cv-3168

Anthony G. Buzbee
(The Buzbee Law Firm)

Anthony G. Buzbee
(The Buzbee Law Firm)

Robert P. Wynne
(Arnold & Itkin, LLP)

John W. deGravelles
(deGravelles, Palmintier,
g )
Holthaus & Fruge)

Anthony G. Buzbee
(The Buzbee Law Firm)

Steve J. Gordon
(Gordon, Elias & Seely)

Kritzer

Joshua

Joshua Kritzer v. Transocean Offshore
Deepwater Drilling, Inc.

2:10-cv-4427

Kurt B. Arnold
(Arnold & Itkin)

Lavergne

Carl

Carl Lavergne v. Transocean, Ltd.

2:10-cv-4211

Morales

Heber

Heber Morales v. BP Exploration and
Production, Inc.

2:10-cv-4360

David P. Bruchhaus
(Mudd & Bruchhaus)

Johnny N. Garza, Jr.
(Abraham, Watkins, Nichols,
Sorrels, Agosto & Friend)

1/12/2011

- 1 -

~7077790.XLS

Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 9 of 16



MDL 2179

In Re: Oil Spill by Deepwater Horizon

Pleading Bundle A Cases

*List comports with BP and Anadarko lists.

Plaintiff
Last Name

Plaintiff
First Name Case Caption

EDLA Docket

Filing Attorney

Murray

Chadwick

Chadwick Murray v. Transocean, Ltd.

2:10-cv-2814

Reed

Darrell

Darrell Reed v. BP, PLC

2:10-cv-4252

George W. Healy, IV
(George W. Healy &
Associates)

Soren E. Gisleson
(Herman, Herman, Katz &
Cotlar)

Rhodes

Karl

Karl Rhodes v. Transocean Offshore
Deepwater Drilling, Inc.

2:10-cv-1502

Richard R. Kennedy

Roberts

Kenneth

Kenneth Roberts v. BP, PLC

2:10-cv-3815

Roshto

Shane

Shane Roshto v. Transocean, Ltd.

2:10-cv-1156

David A. Hilleren
(Hilleren & Hilleren)

Scott R. Bickford
(Martzell & Bickford)

Taquino

Kelli

Kelli Taquino v. Transocean Holdings,
LLC

2:10-cv-1921

John H. Smith
(McKernan Law Firm)

Williams

Michael

Michael Williams v. Transocean, Ltd.

2:10-cv-1243

Paul M. Sterbcow
Lewis, Kullman, Sterbcos &
Abramson)

1/12/2011

- 2 -

~7077790.XLS

Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 10 of 16



MDL 2179

In Re: Oil Spill by Deepwater Horizon

Pleading Bundle C Cases

* List comports with BP, HESI and Anadarko lists.

Plaintiff(s)

Case Caption

EDLA Docket Filing Attorney

City of Greenville, City
of Evergreen, City of
Georgiana, Town of
McKenzie

State of Alabama

State of Alabama

City of Greenville, City of Evergreen, City of
Georgiana, Town of McKenzie v. BP, PLC

2:10-cv-4185

Jere L. Beasley
(Beasley, Allen, Crow,
Methvin, Portis & Miles)

State of Alabama ex rel. Troy King, Attorney
General v. BP, PLC

2:10-cv-4182

Troy King
(Alabama Attorney General)

State of Alabama ex rel. Troy King, Attorney
General v. Transocean, Ltd.

2:10-cv-4183

Troy King
(Alabama Attorney General)

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-1757

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-1758

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-1759

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-1760

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-2087

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-2996

State of Louisiana

State of Louisiana

Camille A. Morvant, II
(D.A., Parish of Lafourche)
(Lafourche Parish)

Stephen B. Murray
(Murray Law Firm)
(Plaquemines Parish)

Victor L. Marcello
(Talbot, Carmouche &
Marcello)
(Terrebone Parish)

Tom W. Thornhill
(Thornhill Law Firm)
(St. Tammany Parish)

Peter J. Butler, Jr.
(Breazeale, Sachse & Wilson)
(St. Bernard Parish)

Victor L. Marcello
(Talbot, Carmouche &
Marcello)
(New Iberia Parish)

Victor L. Marcello
(Talbot, Carmouche &
Marcello)
(St. Mary Parish)

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-2997

State of Louisiana v. Triton Asset Leasing
GmBH

2:10-cv-3059

James D. "Buddy" Caldwell
(Louisiana Attorney General)

1/12/2011

- 1 -

Bundle C Cases.XLS

Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 11 of 16



MDL 2179

In Re: Oil Spill by Deepwater Horizon

Pleading Bundle C Cases

* List comports with BP, HESI and Anadarko lists.

Plaintiff(s)

Case Caption

EDLA Docket Filing Attorney

State of Louisiana

State of Louisiana v. BP Exploration &
Production, Inc.

2:10-cv-2731

State of Quintana Roo,
Mexico

State of Quintana Roo,Republic of Mexico v.
BP, PLC

2:10-cv-4241

State of Tamaulipus,
Mexico

State of Tamaulipus, Republic of Mexico v.
BP, PLC

2:10-cv-4240

State of Veracruz,
Mexico

State of Veracruz, Republic of Mexico v. BP,
PLC

2:10-cv-4239

Leon Cannizzaro, Jr.
(Orleans Parish)

Enrique G. Serna
(Serna & Associates)

Enrique G. Serna
(Serna & Associates)

Enrique G. Serna
(Serna & Associates)

USA

USA

United States of America v. BP Exploration &
Production, Inc.

2:10-cv-4536

Jim Letten

United States of America v. Transocean
Holdings, LLC

2:10-cv-4397

Jim Letten

1/12/2011

- 2 -

Bundle C Cases.XLS

Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 12 of 16



IN RE: OIL SPILL by “Deepwater Horizon”

DIRECT FILING SHORT FORM1

Authorized by Order of the Court, Civil Action No. 10 md 2179 Rec. Doc. 982

(Copies of said Order having also been filed in Civil Actions No. 10-8888 and 10-2771)


SECTION: J

JUDGE CARL BARBIER

MDL 2179

CLAIM IN LIMITATION--JOINDER IN MASTER ANSWER--INTERVENTION AND JOINDER

IN MASTER COMPLAINTS – PLAINTIFF/CLAIMANT PROFILE FORM

By submitting this document, I am asserting a claim in Complaint and Petition of Triton Asset Leasing GmbH, et
al., No. 10-2771; adopt and incorporate the Master Answer [Rec. Doc. 244] to the Complaint and Petition of Triton
Asset Leasing Gmbh, et al., in No. 10-2771; and/or intervene into, join and otherwise adopt the Master Complaint
[Rec. Doc. 879] for private economic losses (“B1 Bundle”) filed in MDL No. 2179 (10 md 2179); and/or intervene
into, join and otherwise adopt the Master Complaint [Rec. Doc. 881] for post-explosion injuries (“B3 Bundle”)
filed in MDL No. 2179 (10 md 2179).

Last Name

Middle Name/Maiden

First Name

Suffix

Phone Number

Address

E-Mail Address

City / State / Zip

INDIVIDUAL CLAIM





BUSINESS CLAIM





Employer Name

Job Title / Description

Address

City / State / Zip

Business Name

Type of Business

Address

City / State / Zip

Last 4 digits of your Social Security Number



Last 4 digits of your Tax ID Number



Attorney Name

Address

Phone Number

Claim filed with BP?

If yes, BP Claim No.:

Firm Name

City / State / Zip

E-Mail Address

YES



NO



Claim Filed with GCCF?: YES



NO



If yes, Claimant Identification No.:

Claim Type (Please check all that apply):





Damage or destruction to real or personal property
Earnings/Profit Loss
Personal Injury/Death








Fear of Future Injury and/or Medical Monitoring
Loss of Subsistence use of Natural Resources
Removal and/or clean-up costs
Other: ___________________________________________


1 This form should be filed with the U.S. District Court for the Eastern District of Louisiana, 500 Poydras  Street, New Orleans, Louisiana  70130, in Civil Action No. 
10?8888.  While this Direct Filing Short Form is to be filed in CA No. 10?8888, by prior order of the Court, (Rec. Doc. 246, C.A. No. 10?2771 and Rec. Doc. 982 in MDL 
2179), the filing of this form in C.A. No. 10?8888 shall be deemed to be simultaneously filed in C.A. 10?2771 and MDL 2179.  Plaintiff Liaison Counsel, after being 
notified electronically by the Clerk of Court of the filing of this Short Form, shall promptly serve this form through the Lexis Nexis service system on Defense Liaison. 

The filing of this Direct Filing Short Form shall also serve in lieu of the requirement of a Plaintiff to file a Plaintiff Profile Form.

1






Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 13 of 16




Brief Description:

1. For earnings/profit loss, property damage and loss of subsistence use claims, describe the nature of the injury. For claims
involving real estate/property, include the property location, type of property (residential/commercial), and whether physical
damage occurred. For claims relating to fishing of any type, include the type and location of fishing grounds at issue.
















2. For personal injury claims, describe the injury, how and when it was sustained, and identify all health care providers and

employers 2008 to present and complete authorization forms for each.






























3. For post-explosion claims related to clean-up or removal, include your role in the clean-up activities, the name of your

employer, and where you were working.

The filing of this Direct Filing Short Form shall also serve in lieu of the requirement of a Plaintiff to file a Plaintiff Profile Form.

2






Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 14 of 16



Please check the box(es) below that you think apply to you and your claims:
Non-governmental Economic Loss and Property Damage Claims (Bundle B1)


1.

Commercial fisherman, shrimper, crabber, or oysterman, or the owner and operator of a business involving fishing, shrimping,
crabbing or oystering.

2.

Seafood processor, distributor, retail and seafood market, or restaurant owner and operator, or an employee thereof.

3. Recreational business owner, operator or worker, including a recreational fishing business, commercial guide service, or charter

fishing business who earn their living through the use of the Gulf of Mexico.

4.

Commercial business, business owner, operator or worker, including commercial divers, offshore oilfield service, repair and
supply, real estate agents, and supply companies, or an employee thereof.

5. Recreational sport fishermen, recreational diver, beachgoer, or recreational boater.

6.

Plant and dock worker, including commercial seafood plant worker, longshoreman, or ferry operator.

7 Owner, lessor, or lessee of real property alleged to be damaged, harmed or impacted, physically or economically, including

lessees of oyster beds.

8.

Hotel owner and operator, vacation rental owner and agent, or all those who earn their living from the tourism industry.

9. Bank, financial institution, or retail business that suffered losses as a result of the spill.

10. Person who utilizes natural resources for subsistence.

11. Other:

























Post-Explosion Personal Injury, Medical Monitoring, and Property Damage Related to Cleanup (Bundle B3)


1.

Boat captain or crew involved in the Vessels of Opportunity program.













2. Worker involved in decontaminating vessels that came into contact with oil and/or chemical dispersants.

3. Vessel captain or crew who was not involved in the Vessels of Opportunity program but who were exposed to harmful chemicals,

odors and emissions during post-explosion clean-up activities.

4. Clean-up worker or beach personnel involved in clean-up activities along shorelines and intercoastal and intertidal zones.

5. Resident who lives or works in close proximity to coastal waters.

6.

Other:

















Both BP and the Gulf Coast Claims Facility (“GCCF”) are hereby authorized to release to the Defendants in MDL
2179 all information and documents submitted by above-named Plaintiff and information regarding the status of any
payment on the claim, subject to such information being treated as “Confidential Access Restricted” under the Order
Protecting Confidentiality (Pre-Trial Order No. 11), and subject to full copies of same being made available to both
the Plaintiff (or his attorney if applicable) filing this form and PSC through Plaintiff Liaison Counsel.


Claimant or Attorney Signature

Print Name

Date

The filing of this Direct Filing Short Form shall also serve in lieu of the requirement of a Plaintiff to file a Plaintiff Profile Form.

3






Last Name

Phone Number

Address

INDIVIDUAL CLAIM
Employer Name

Job Title / Description

Address

City / State / Zip

Social Security Number

Attorney Name

Address

Phone Number

Claim filed with BP?

If yes, BP Claim No.:

SECTION: J

PLAINTIFF PROFILE FORM [“PPF”]
First Name

Middle/Maiden

JUDGE CARL BARBIER

Suffix





E-Mail Address

City / State / Zip

BUSINESS CLAIM
Business Name

Type of Business

Address

City / State / Zip

Tax ID Number

Firm Name

City / State / Zip

E-Mail Address







YES



NO



Claim Filed with GCCF?:

YES



NO



If yes, Claimant Identification No.:

Damage or destruction to real or personal property;

Earnings/Profit Loss;

Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 15 of 16

IN RE: OIL SPILL by “Deepwater Horizon”



MDL 2179 and Civil Action No. 10-2771

Claim Type (Please check all that apply):

Personal Injury/Death;


Removal and/or clean-up costs;

Fear of Future Injury and/or Medical Monitoring;

Loss of Subsistence use of Natural Resources;



Other _______________________________________________________

Original Case Caption

Originating Court

Original Civil Action Number

EDLA Civil Action Number

Please check the box(es) below that you think apply to you and your claims:
Non-governmental Economic Loss and Property Damage Claims (Bundle B1)

Commercial fisherman, shrimper, crabber, or oysterman, or the
owner and operator of a business involving fishing, shrimping,
crabbing or oystering.

Seafood processor, distributor, retail and seafood market, or

restaurant owner and operator, or an employee thereof.

Recreational business owner, operator or worker, including a
recreational fishing business, commercial guide service, or charter
fishing business who earn their living through the use of the Gulf of
Mexico.

Commercial business, business owner, operator or worker, including
commercial divers, offshore oilfield service, repair and supply, real
estate agents, and supply companies, or an employee thereof.

Plant and dock worker, including commercial seafood plant worker,

longshoreman, or ferry operator.

Owner, lessor, or lessee of real property alleged to be damaged,
harmed or impacted, physically or economically, including lessees of
oyster beds.

Hotel owner and operator, vacation rental owner and agent, or all

those who earn their living from the tourism industry.

Bank, financial institution, or retail business that suffered losses as a

result of the spill.

Person who utilizes natural resources for subsistence.
Other:













Recreational sport fishermen, recreational diver, beachgoer, or

recreational boater.



Post-Explosion Personal Injury, Medical Monitoring, and Property Damage Related to Cleanup (Bundle B3)

Boat captain or crew involved in the Vessels of Opportunity

program.

Clean-up worker or beach personnel involved in clean-up activities

along shorelines and intercoastal and intertidal zones.

Worker involved in decontaminating vessels that came into contact

with oil and/or chemical dispersants.

Vessel captain or crew who was not involved in the Vessels of
Opportunity program but who were exposed to harmful chemicals,
odors and emissions during post-explosion clean-up activities.








Resident who lives or works in close proximity to coastal waters.
Other:





















Case 2:11-cv-00516-CJB-SS Document 3-3 Filed 03/09/11 Page 16 of 16


Brief Description:

For earnings/profit loss, property damage and loss of subsistence use claims, describe the nature of the injury. For claims
involving real estate/property, include the property location, type of property (residential/commercial), and whether physical
damage occurred. For claims relating to fishing of any type, include the type and location of fishing grounds at issue.

















For personal injury claims, describe the injury, how and when it was sustained, and identify all health care providers and employers
2008 to present and complete authorization forms for each.















For post-explosion claims related to clean-up or removal, include your role in the clean-up activities, the name of your employer,
and where you were working.














Both BP and the Gulf Coast Claims Facility (“GCCF”) are hereby authorized to release to the Defendants in MDL 2179 all
information and documents submitted by above-named Plaintiff and information regarding the status of any payment on the claim,
subject to such information being treated as “Confidential Access Restricted” under the Order Protecting Confidentiality (Pre-Trial
Order No. 11), and subject to full copies of same being made available to both the Plaintiff (or his attorney if applicable) filing this
form and PSC through Plaintiff Liaison Counsel.

________________________________________________
Claimant or Attorney Signature








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Date