Document 3NMRKONerOJ94Ywwz2eRQx15x
FILE NAME Mundet Cork MCK
DATE 1963 DOC MCK134
DOCUMENT DESCRIPTION WC Claim of Everitt Pt 3
-
WORKERS COMPENSATION AFFEALS BOARD
STATE OF CALIFORNIA
3 ALLEN EVERITT 4
CASE No. 63 OAK 11139
5 Applicant
6
VS
7 WESTERN ASBESTOS COMPANY et al
and STATE COMPENSATION
INSURANCE FUND et al
CERTIF CATION CERTIF CE I RC TI A FI T CI ATO IO N N
Defendant
10
1111
12 13 14 15 16
I hereby certify that the attached documents are true and correct copies of the original documents filed in the records of this office in the entitled matter
ATTEST my hand and the Seal of the Workers Appeals Board of the State of California
Compensation
C. WILLIAMS
Workers Workers
Compensation Judge
Compensation Appeals
Board
Dated at San Francisco California this 16th day
of
April 1984
DIA WCAB FORN 19 NEW 1
wou TOP TOP
DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION DIVISION OF INDUSTRIAL ACCIDENTS
KirKiwrwanaKirnwan
san francisco ca 9410
415 664.3062
LEGAL DOCUMENT DUPLICATING SERVICE
PERTAINING TO ALLEN EVERITT
WORKER'S COMPENSATION APPEALS BOARD
SAN FRANCISCO
Case NO
Applicant
63 OAK
11139
= Everitt
Allen
Da
Injury
463-1-63
Employer
Western Asbestos
Asbestos wkr
Carrier
Self
SCIF only
But see SCIF's Petition for Joinder Order Joining Defendants 1-28-64
Petition to Dismiss ECIF's previous
Order Dismissing 9-16-66
1-22-64 Petition
9-12-66
Per
Type Adi Order Cge
1946- A 3,63 8-5-63
Supp &
5-19-64 5-19-64
PD 1-31-64
Reference
- Contributors Armstrong Cork Co.
Armstrong Contract
ing & Supp Co. Charles Ayers Co. E. J. Bartells Co. C. F. Braun & Co. P. Carey Mfg Co.
T.C.Douglass Jr.
Fluor Maintenance
Mundet Cork Corp. Owens Corning Fiberglass Plant Asbestos Co. Thorpe Insultn Charles Ayers Co.
H. Lorentzen Co. Plant Asbestos Co
Reliance Ins Co.
Suc
Acc
to Standard Ins Co.
Traveler
Argonau Employer
Amer MO Cen Acc U.S. Fid Cont Cas
Aetna Cas
Amer Emplo
Fireman's FL
Indus Indem
ee
MER
Wr
I 2 3
d --
G
7 8
0
10
11
1212
1313 1414
15 15 20 17
18
BEFORE THE DIDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA
ALLEN EVERITT
CLAIN NO 63 OAK 11139
qs
3
Applicant
V3
FINDINGS AND AWARD
re
WESTERN ASRESTOS COMPANY and STATE COMPENSATION INSURANCE
FUND
!
F
703-1955
Defendants
An Application having been
. |.
he
filed herein
all
parties
having appeared and the matter having been regularly heard before
Olney L. Huff Referee and submitted for decision said Referee now
makes his Findings and Award as follows
FINDINGS OF FACT
1. Allen Everitt born March 7 1900 sustained an injury
out
arising
of and occurring
in
the
course
of
his
employment
con-
r
4 sisting of asbestosis caused by his exposure to asbestos while in th
AT employ of Western Asbestos Company for the period 1946 to March 1
1953 ao an acbector worker
At said time the employer's insurance
carrier was State Compensation Insurance Fund
| May
ing
2. Said injury caused temporary total disability beginni 1 1963 to and including August 1 1963 and continuing entit applicant to compensation during said period at the rate of
23 23
70.00 a week based upon maximum earnings
24 24
3. The evidence is insufficient to indicate apportionmer
25 25
4 Applicant is in need of further medical treatment to
cure or relieve from the effects of the injury herein
5. Applicant has incurred the expense of a medical repo
from W. R. Brode M. D. in the sum of 15.00 and the expense of
29 j examination report rays and laboratory tests from Joseph Ross
re30
M. D. in the sum of 112.50 necessary to successfully prove his
ene,
ae
wars
1
}
-
claim and is entitled to be reimbursed for the
same payment of
=
1 2 15.00 to be made to Dr. Brode and 112.50 to Dr. Ross
3
6 Applicant is entitled to
reimbursement for pro-
4 cured medical treatment the matter to be adjusted by the parties {;
--
7. The Department of Employment has paid unemployment
fa} compensation disability benefits and is entitled to a lien against 7 unpaid compensation at the rate of 70.00 a week for the period j
8
beginning May 1 1963 to and including July 14 1963
9
B. Defendants were not
prejudiced through lack of notice
10
9. The injury herein was caused by applicant's employment
11 on land and the Commission has jurisdiction of the case
12
10. Applicant became disabled and first had knowledge that
13
his disability was the result of his
employment within one year
14
prior to the filing of the application for
compensation benefits and
15
the claim is not barred by the statute of limitations
16
11 Applicant's attorneys Smith Parrish Paduck & Clancy
; 17
have performed legal services of the
reasonable value of 75.00 and
Ia are entitled to a lien in
19 | which is to take priority
20
Employment
said amount of the lien
against unpaid compensation claim of the Department of
21 AWARD
22 23 24 25 25 27 23 29
AWARD IS MADE in favor of ALLEN EVERITT against STATE
COMPENSATION DISURANCE PUID of temporary disability indemnity at the i
| rate of 70.00 a week beginning May 1 1963 to and including
f
August 1 1963 and indefinitely thereafter until the further order
of this Commission less the sum of 75.00 payable to Smith Paduck and Clancy as an attorneys fee and less the lien of
Parrish
the
Department of Employment at the rate of 70.00 a week for the
period
} beginning Hay 1 1963 to and including July 14 1963
OL ty
.
OAK 11130 4 } Brow te
t Me ver
t
1 2 3 4
Lo]
6 7 8 0 10
11 12
13
14
STATE
AWARD IS COMPENSATION
FURTHER MADE in favor of ALLEN EVERITT against
DISURANCE FUND of further medical treatment to
cure or relieve from the effects of the injury herein
STATE
AWARD IS COMPENSATION
FURTHER MADE in favor of ALLEN EVERITT against INSURANCE FUND of medical costs in the sum
of 127.50 payable as follows 15.00 to W. R. Brode M. D. and
112.50 to Joseph Ross D.
AWARD IS FURTHER MADE in favor of ALLEN EVERITT against STATE COMPENSATION DISURANCE FUND of reimbursement of the reasonable medical expense incurred by applicant for the cure or relief of the injury herein
IT IS ORDERED that State Compensation Insurance Fund report to this Commission on Form No. 5 within ten days after
cessation of payments under the above continuing award
1
fl
cy
atat
da
H
teal
HUFF REFER^ E INDUSTRIAL ACCIDENT COMMISSION
25
DATE FILED AND SERVED August 5 1963 ty
26
Allen Everitt 449 - 22nd St. Richmond Calif
Smith Parrish Paduck & Clancy 315 Pinancial Center Bldg Oakland
27
Western Asbestos Co. 675 Townsend St. San Francisco Calif
State Compensation Insurance Fund Personal Service
28
Department of Employment Personal Service
2
OLH ,
| RI OAK 11139 Fees
eee
i>
oe,
Ow
we
ssa
- ee
t eat Aen cart Cann ean : >
JAL :
BEFORE THE INDUSTRIAL ACCIDENT COLISSION
rtbe,
OF THE STATE OF CALIFORNIA
CLAIM NO 63 OAK 11139
ALLEN EVERITT
V3 Applicant
WESTERN ASBESTOS COMPANY and STATE COMPENSATION INSURANCE FUND
Defendanto
.
PETITION TO JOIN ADDITIONAL EMPLOYERS AND INSURANCE CARRIERS
as
TO THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OP CALIFORNIA PANEL ONE
Defendants Western Asbestos Company and State Compensation Insurance Fund petition this Commission for an order directing that additional defendants be joined in this
mitter because
1. Applicant Allen Everitt alleges that in the
ae
period beginning 1946 and continuing through 1963 he developed
ie an occupational disease arising out of and in the course of
his employment
2. Applicant was in the employ of defendant Western
N
Asbestos Company for parts of the following quarters
Te N
6/30/45
9/30/50
9/30/46
17/31/50
25
6/30/47
3/31/51
PE 9/30/117
6/30/51
26
17/31/17
9/30/51
3/31/48
6/30/52
N
6/30/48
9/30/52
9/30/418
12/31/52
N
12/31/18
3/31/53
3/31/49
6/30/53
N
6/30/49
9/30/53
Pe 9/30/49
3/31/54
WS
Sk and for no other time
6/30/54 9/30/54 3/31/55 6/30/55
3/31/57
6/30/57 9/30/57 12/31/57 6/30/59 3/31/59 6/30/59 9/30/59
3/31/60 6/30/60 9/30/60 17/31/60
3/31/61
6/30/61 9/30/61 3/31/62 9/30/62 12/31/62
3/31/63
WS
a
32
.
fa,
1
3 Defendants Western Asbestos Company and State
Compensation Insurance Fund allege that all or part of appli-
2 cant's alleged occupational disease if shown to have been
&F
the result of industrial causation arose out of and in the
course of employment for employers other than defendant
7 Western Asbestos Company and was wholly or partially contracted in the period beginning 1946 and continuing through
1963
8
4 Defendants Western Asbestos and State
10 10
Compensation Insurance Fund allege that applicant was employed
222 222
by the following employers insured by the carriers indicated
222
as follows
2 222 ---14
INVEIL ed
reed
ee Nae b
ee meron
15 15
Astrong Cork Co.
Standard Accident
Liberty & Charlotte
Insurance Company
18
Lancaster Penn
433 California California Street
9/30/51 12/31/51
17 18
Son Prineisco Calif
and
Esployers Mutual Liability
18 18
Insurance Co. of Wis
114 Gancome Street
19 19
San Francisco 4 Calif
20 20
Armstrong Contracting
Travelers Insurance Co.
and Supply Corp.
1956 Webster Street
21 21
120 Ling Street
Oakland Oakland 17 California
Lancaster Penn
12/31/58 12/31/59
3/31/60
22 22
Charles A ---- ------
23 23
374 Brannan Street
Industria Indemnity Co.
350 Sonsome Street
Son Prunstuco 7 Cal
San Francisco Calif
24 24
200
17/31/51 9/30/58
12/31/58
Argonaut Insurance Co.
25 25
550 California Street
San Francisco C.lif
8 26
Charles Ayres Supply
Industrial Indemnity Co.
27 27
Company Inc.
350 Sinsome Street
692 Minnesota Street
San Francisco Calif
28 28
Son Prancisco 7 Cal
an
3/31/52 6/30/55 12/31/55
Argonaut Insurance Co.
29 2
550 California Street
San Francisco Calir
30 30
31 The E. J. Hortello Co. Employers Mutual Liability Liability
6/30/61
31
1212 Sixth Ave. S.
Insurance Co. of W1o
9/30/61
Seattle 4 Wash
114 Sunsome Street
32
San Francisco 4 Calif
2
e ri
wT
1
2
3 C. P. Braun & Company A Corporation 1000 S. Fremont Ave. Alhambra California
American Hatorists
Insurance Conany 417 Montgomery Street San Francisco 4 Calif
12/31/57 3/31/58 6/30/58
The Philip Chry
Manufacturing Co.
6
Lockland
Cincinnati 15 Ohio 7
General Accident Pire and
Life Insurance Corp.
.
Ltd.
.
600 California Street
San Francisco Calif
12/31/56
a) 8
Thomas C. Douglass Jr. United States Fidelity &
9/30/55
ia
Douglass Insulation Co.
Guarantee Company
9
2233 Ingalls Street
444 California Street
San Francisco 24 Cal San Francisco Calif
Oe
11 11
Fibreboard Paper Products Corp.
insured
12/31/47
1789 Montgomery Street
San Francisco 11 Cal
13 12 Pluor Maintenance Inc. Arcociated Inlegnity Corp. 0.5 0.5 701
9/30/55
15 406 Word Street Martino California
Sun Francisco California
15
Fluor Maintenance Inc. Continental Casualty Co.
16 16
Box 7030
433 California Street
12/31/58
2500 E. Washington
San Francisco California
17
E. Los Angeles 22 Cal
1718
Insulation & Asbestos
Ind Morks of N. Cal
19
Vic Trust Fund local
9/30/55 9/30/59
22 20
15. 16 200 Cueenero Street
Sam Pennalaco 3 Cal
N N21
23
NN 25NNN
26 27 28
29
30 31
Harold G. Lorentzen
Lorentzen Company
1155 Fifth Street
land California
Hundet Cork Corp. 2101 Tonnelle Ave. N. Bergen New Jersey
Ovens Corning Fiberglas
International F. S. Subsidiary of Quena Corning Fiberglas
Corp. P. O. Box 901 Toledo 1 Ohio
Industrial Indemnity Co.
350 Corso Street
San Francisco California
Aetna Casualty and Surety Corpany
1330 Broadway Oakland California
Aetna Casualty and Surety Company
1330 Broadway Oakland California
9/30/55 17/31/55 17/31/55
3/31/57
3/31/59
3/31/52
12/31/61
-
3/31/62
9/30/55 3/30/55 6/30/58
9/30/53
12/31/59
9/30/60
32
2 3 4 5 8
7
8
9 232 232 232 12 13 14 15 16 17 18 19 20 21 22 23 24 25 20 22 28 29 30 31 32
Plant Asbestos Co. 1300 - 64th Street
Everyville
Oakland 8 Calif
Industrial Indemnity Co. 350 Sansome Street Son Francisco California
and
American Employers Insurance Company
Russ Building San Francisco Calif
Thorpe Insulation Co.
A Corporation
2741 S. Yates Ave.
Los Angeles 22 Calif
3/31/52
6/30/55
3/31/55 6/30/56 9/30/56 12/31/56 9/30/59
12/31/50 9/30/61
9/30/62
9/30/55
5. Defendants Western Asbestos Company and State
Compensation Insurance Fund attach herewith as part of this petition a copy of the report of the Department of Health Education and Welfare Social Security Administration signed by Robert M. Mayne Chief that pertains to Mr. Allen Everitt's employment during the aforementioned time
State
WHEREFORE defendants Western Asbestos Company Compensation Insurance Fund respectfully pray that
and an
order issue directing that the aforementioned employers and
insurance carriera be joined as defendants in this matter and granting all other and further relief that may be necessary
and proper
Dated January 20 1954
T
4
.
?
/
M
Miller Miller
.
Miller
CHAHILLAT CHAHILLAT
CHAHILLAT
Attorney for Defendants
Western Asbestos Company
State Compensation Insurance Fund
eked
teats
ee
a tn
to
nach.
ee
os
oar
RP
1
PROOF OF SERVICE BY 10133 2015.5 C.C.P.
2
STATE OF CALIFORNIA
COUNTY OF ALAMEDA
3
address am a resident of the United States and a resident of the
8
aforesaid county I am over the age of eighteen years and
not a party to the within above action ny business
5
is
.
3360 Grand Avenue Ockland 10 California
@
ens On January , 1964 I served the within PETITION TO JOIN
7
Bi
ADDITIONAL EMPLOYERS AND INSURANCE CARRIERS on the various
8
ie
parties in said action by placing a true copy thereof en-
9
, |
mre closed in a sealed envelope with postage thereon fully pre-
10
paid in the United States post office rail box at Elwood
11
and Grand Avenues in Oakland California addressed as follows
12
13
Armstrong Cork Company Liberty and Charlotte Streets
Loreaster Ponylvania
14
Standard .ccident Insurance Company 432 California Street
San Francisco California
15
Employers Kutual Liability Insurance Company of Wisconsin
114 Sansome Street San Francisco 4 California
18
Armstrong Contracting and Supply Corporation 120 North Lime
Street Lancaster Pennsylvania
17
Travelers Insurance Corpany 1956 Webster Street Oakland 12
CaliforniCaalifornia
18
Charles Ayres Commony 370 Brannan Street San Prancisco 7
California
19 InCdausltirfioarlniaIndemnity Company 350 Sansone Street San Francisco , Tey?
20
Aegonaut Insurance Company 550 California Street
San Francisco California
PCry
21 ChaSralnesFraAnycriesscoSup7plyCalCiofmopranniya Inc. 638 Minnesota Street aT
22
The E. J. Bartells Company 1212 Sixth Avenue South Seattle 4
Mashir
NNN
P. Braun and toany A Corporation 1000 South Fremont
Avenue Alambra California
NNN AmSearnicaFnranbctiosrciost4s CIanlsiufroarnnciea Company 417 Montgomery Street
NNN TheOniPohilip Cary Manufacturing Company Lockland Cincinnati 15
26
General Accident Fire and Life Insurance Corporation Ltd
600 California Street San Francisco California
27
Thoras C. Douglass Jr. Douglass Insulation Company 2733
Ingalls Street San Francisco 24 California
28
United States Fidelity and Guarantee Company 444 California
Street San Francisco California
29 FiSbtrneboFarradnciPsacpoer 1P1roCdaucltisforCnoiraporation 1789 Montgonery Street
30
Fluor Maintenance Inc. P. O. Box 791 405 Ward Street
Martinez California California
31
Associated Indemnity Corporation 337 Pine Street
San Francisco California
32
e
ee
e
re 1
Fluor Hintenance Inc. Box 7030 2500 East Washington Street
East Los Angeles 22 California
e 2
Continental Casualty Company 433 California Street
San Francisco Callfornia
3
Insulation and Asbestos Industry Works of North California
en
Vocation Trust Fund Local No. 16 200 Guernero Street
4
San Francisco 3 California
Harold G. Lorentzen Lorentzen Company 1155 Fifth Street
.
5
Oakland California
.
|
Kundet Cork Corporation New Jersey
2101 Tonnelle
Avenue
North Bergen
Aetna Casualty and Surety Company 1330 Broadway Oakland
California
Owens Corning Fiberglas International F. S. Subsidiary of Owens Corning Fiberglas Corporation P. O. Box 901 Toledo 1 Ohio
Plant Asbestos Company 1300 - 64th Street Emeryville
Oakland 8 California
10
American Employers Insurance Company Rusa Building
Sun Francisco California
11
Thorpe Insulation Company A Corporation 2741 South Yates
Avenue Los Angeles 22 California
12
13
I certify under penalty of perjury that the foregoing is
14
true and correct
15
Executed on January29 , 1964 at Oakland California
lls
JeaniLe. Rucker
c - Smith Parrish Paduck and Clancy
Attorneys at L w
315 Financial Center Building Oakland 12 California
28
NNN
30
31
The proof of service by mail form being signed under
of perjury does not require notarization
penalty
32
ee
1
N
M
A
5
10 11 12
20 21 22 23
BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA
CLAIM NO 63 OAK 11139
ALLEN EVERITT
Applicant
.
FINDINGS AND AWARD FOR
a?
PERMANENT DISABILITY
v3
1 of ee ie oe eri eeeny | :
n
Tee Pare
{ WESTERN ASBESTOS COMPANY and
FILED
>
STATE COMPENSATION INSURANCE FUND
1227
weal 10 1227
1
Defendants
fe
a fe
herein
awe
Petition for Permanent Disability Rating having been filed nse
all parties having appeared and the matter having been
ae
wo regularly heard before Olney L. Huff Referee and submitted said
Referee now makes his decision as follows
FINDINGS OP FACT
. The injury herein caused permanent disability of 100
2. Applicant's attorneys Smith Parrish Paduck & Clancy have performed legal services of the reasonable value of 1,000.00 and are entitled to a lien in said amount against unpaid compensation
AWARD AWARD IS MADE in favor of ALLEN EVERITT against STATE
COMPENSATION INSURANCE FUND of permanent disability indemnity at the rate of 52.50 a week beginning January 31 1964 and continuing until 400 weekly payments shall have been made in the total sum of 21,000.00 and thereafter a life pension at the rate of 48.46 a
week less the sum of 1,000.00 payable to Smith Parrish Paduck &
Clancy as an attorneys fee
NNN 23 30 OLHI ty
S
S
HUFF
S ACCIDENT INDUSTRIAL ACCIDENT
REFEREE
REFEREE
COMMISSION
All parties served as shom on Official Address Record May 19
1964
ty
ene f--s 1?
a we
Ne
-~
~
OLNEY L. HUFF Oakland - April
REFEREE
27 1964
EVERITT
CLAIM OAK 11139
11996633 1946 to March 1
REPORT OF REFEREE ON SUPPLEMENTAL HEARING
ISSUE
Permanent disability
APPLICANT testified substantially as follows
He doesn't do anything except just look at the walls
He is shortwinded and doesn't walk
in the yard or dusts a little
He
meals in restaurant
very good can't cook
He just sits He eats his
He has had no clerical training
He drove to Dr. Griffcath He make short trips driving He can't sit too long When he walks a block and a half he has
to stop and rest because he has shortness of breath
DISPOSITION
Within the discretion of the Referee case to be referred to
the Permanent Disability Rating Bureau seven days to the parties for rebuttal of its report Case otherwise submitted
OLH RN
OLNEY L. HUFF REFEREE
May 19 1964
REPORT OF REFEREE ON DECISION
Applicant has a permanent disability as a result of the injury herein and the factors of such disability were
submitted to the Rating Bureau based upon the medical and applicant's testimony A rating of 100 has been
evidence
recom-
mended and applicant is entitled to an award for the amount of
compensation represented by such rating
OLH ty
AZwet, Z
ae
OLNEY
L. HUPF HEFEREE
HEFEREE
1
we
ane
WORKMEN'S COMPENSATION APPEALS BOARD STATE OF CALIFORNIA
ov te
ALLEN EVERITT
et
& ce
Applicant
CASE NUMBER
un Vtecrps
V5
63 OAK 11139
--
WESTERN ASBESTOS CO and
STATE COMPENSATION INSURANCE FUND
|
ARMSTRONG CORK COMPANY
B ARMSTRONG & CONTRACTING SUPPLY CORP CHARLES AYRES SUPPLY
CHARLES AYRES SUPPLY CO INC THE E. J. BARTELLS BARTELLS CO
F. BRAUN & COMPANY
THE PHILIP CARY MANUFACTURING CO
CO 11
THOMAS C. DOUGLASS JR DOUGLASS
INSULATION
12 PIEREBOARD PAPER PRODUCTS CORP
FLUORMAINTENANCE INC
HAROLD G. LOKENTZEN LORENTZEN CO 13 MUNDET CORK CORP
ORDER DISMISSING PETITION TO JOIN ADDITIONAL EMPLOYERS AND INSURANCE CARRIERS
)
OWENS FIBERGLAS OWENS CORNING
14
PLANT ASBESTOS CO THORPE INSULATION CO
15
ACCIDENT INSURANCE CO
STANDARD INSURANCE EMPLOYERS MUTUAL LIABILITY INSURANCE
OP WISCONSIN
TRAVELERS INSURANCE COMPAITY
| ) INDUSTRIAL INDEMNITY COMPANY ARGONAUT INSURANCE COMPANY AMERICAN MOTORISTS INSURANCE CO
COMPANY
GENERAL ACCIDENT PIRE & LIFE INSURANCE CORP.LTD
UNITED STATES FIDELITY & GUARANTEE CO
ASSOCIATED NITY CORP
CONTINENTAL CASUALTY CO
AETNA CASUALTY & SURETY CO AMERICAN EMPLOYERS INSURANCE CO
eee
Defendants
weet
63 -- -- --
11133
ferw ais
|
Pursuant to Request of State Compensation Insurance Fund and
GOOD CAUSE APPEARING THEREFOR
1
IT IS ORDERED that the Petition to Join Additional Employers
and Insurance Carriers filed by State Compensation Insurance Pund on
January 22 1964 be and it is hereby
SERVICE UPON ALL PARTIES AS SHOWN ON dismissed RICHARD A HICTOSAN
OFFICIAL ADDRESS RECORD September 16 1966 hg SEAL
H. Geltunger Geltunger
e,
Referee
--
.-
-.
C
oe
.
5
.
{
A02967
fy cote,
AC
wads
Sp: oee, +, .
ye c
APPEALS BOARD 1.12
APPEALS APPEALS
-
BEFORE THE WORKMEN'S COMPENSATION
wa
2 1965
2
OF THE STATE OF CALIFORNIA
oo:
~
,, fl 11139
Te
3
CLAIN NO 63 OAK 11139
Nr
hes
CARD Maw 2 CARD
uo
& ALLEN EVERITT
A
Applicant
6 VS.
7 FESTERN ASBESTOS COMPAITY and STATE COMPENSATION
B
INSURANCE Furm et al
:
PETITION TO DISMISS STATE COMPENSATION INSURANCE FUND'S PETITION TO JOIN ADDITIONAL
EPLOYERS AND INSURANCE CARRIERS FILED JANUARY 21 1964
9 Defendants
10
On January 21 1964 the State Corpensation Insurance
ne
Fund filed a PETITION TO JOIN ADDITIONAL EMPLOYERS AND INSURANCE
1313
14
310 4
1818
17
18
19
CARRIERS in the action herein
The following named carriers have prreed to by the following turs to defendant State Compensation Insurance Fund in regard to its claim for apportionment and reimbursement
COURT SHO
Reliance Insurance Co.
as successor to Standard Accident Insurance Co.
KOPLOYERS KOPLOYERS KOPLOYERS Armstrong Cork Co.
AMOUNT TO B. PAID TO CCIF
$ 297.78
20
Tervelers Insurance Co.
Amstrong Contracting & Supply Company
391.40
21 21
Argonaut Insurance Co.
Charles Ayers Co.
450.87
22
Eployers Putual of Wausau E.J. Bartolls Co.
185.37
23 American Fotorists Ins Co. C. F. Broun & Co.
1038.89
24
General Accident Fire &
The Philip Cary Ifg Co.
25
Life Assurance Corp. Ltd.
236.80
28
U.S. Fidelity & Guaranty Co.Thomas C. Douglass Jr.
105.66
27
Continental Casualty Co.
Fluor Maintenance Inc.
122.44 122.44
28
Actna Casualty & Surety Co. Mundet Cork Corp. &
1810.57
Ovens Corning Fiberglass
29
American Exployers Ins
Plant Asbestos Co.
99.91
30
Fireman's Fund Insurance Co.Thorpe Insulation Co.
31
55.56
Industrial Indernity Co.
32
Charles Ayers Co. Harold G. Lorentzon Co.
2376.00
and Plant Asbestos Co.
TOTAL
51722.21 51722.21
os
-~
1 WHEREFORE Western Asbestos and Stite Stite Compensation
2 Insurance Fund request that the PETITION TO JOIN ADDITIONAL
3 EMPLOYERS AND INSURANCE
filed
CARRIERS
on January 21 1954 be
4 dismissed rith prejudice
,
@2
f
Respectfully cubmitted
8
7
8
9
Dated_at Dated_at
this 6th
Oakland Califomia
1965
day of September 1965
C. M. Melillan Melillan Attorney
for Western Asbestos and
State Compensation Insurance
Fund
1150
1717
19
20222
C - Hanna & Brophy Attorneys at Law 1540 San Pablo Avenue Orkland California
C - Iconard Gosh'tin & Bancroft Attorneys at Lawy
311 California Street San Francisco California C - Continental Casualty 433 California St.
San Francisco California Attn John X.
Wilkes
C - Employers atual Liability Insurance Co. A5t5t0n ChilBforiniallChilPfaorrniraisSht. Son Francisco California
C - Henry G. Sanford Attorney at Law Hobart Building Sen Francisco California
C - Sedgwick Detert Moren & Arnold Attorneys at Law 111 Pine Street San Francisco California
222
23
26 27 28 29 30 31 82
a
|
1
yoo
.
RK
\.
lez
228
Allen Everitt - Claim No. 63 OAK 11139 ~~
8 DATE ORDER JOINING PARTY DEFENDANTS FILED AND SERVED
3
Allen Everitt 449 - 22nd St. Richmond Calif
Smith Parrish Paduck & Clancy 315 Financial Center Building
hk
Oakland 12 California 440 Valley Drive Drive Brisbane
Western Asbestos Co.
Townsend St. ,
Francisco Calif
BA
State Compensation Insurance Fund 3360 Grand Avenue
Oakland 10 California Personal Service
8
Armstrong Cork Co. Liberty & Charlotte Sts Lancaster Pennsylvania
Armstrong Contracting & Supply Corp. 120 N. Lime St. Lancaster
Pennsylvania
7
Charles Ayres Co. 37 Brannan St. Can Francisco 7 California
Charles Ayres Supply Co. Inc. G98 Minnesota St. San Francisco
California
2
= =
~gy 22IA 5298222
22IA 5298222
hen 22IA 5298222
fy 22IA 5298222
22IA 5298222
oy 22IA 5298222
s
22IA 5298222
etite 22IA 5298222
e doe 22IA 5298222 22IA 5298222
22IA 5298222
The E. J. Bartells Co. 1212 Sixth Ave. S. Seattle 4 Washington C. P. Braun & Company 1000 S. Premont Ave. Alhambra California
The Philip Cary Manufacturing Co. Lockland Thomas C. Douglasa Jr. Douglass Insulation
San Francisco 24 Calif
Cincinnati 15 Ohio Co. 2233 Ingalls St.
Fibreboard Paper Producto Corp. 1769 Montgomery St. San Francisco
California
Fluor Maintenance Inc. P. O. Box 791 406 Ward St. Martinez Calif
Fluor Maintenance Inc. Box 7030 2500 E. Washington E. Los Angeles 22 California
-Insula - C t ai lV o a n c 10,16,200 Franci Francis sco -Cc alo ~-r
Harold C. Lorentzen Lorentzen Co. 1155 Fifth St. Oakland Calif Mundet Cork Corp. 2101 Tonnelle Ave. H. Bergen New Jersey
Owena Corning Fiberglas International F. S. Subsidiary of Ovens
Corning Fiberglas Corp. P.O. Box 901 Toledo 1 Ohio
Plant Asbestos Co. 1300 - 64th St. Emeryville Oakland 8 Calif
Thorpe Insulation Co. a corporation 2741 S. Yates Ave. Los Angeles 22 Calif
Standard Accident Insurance Co.
California ,
ad
433 California
:
San Francisco
---
Employers
Travelers
Travelers
Mutual Liability Insurance Company of Wisconsin 114 Sansome St. San Francisco Calif Insurance Co. 1956 Webster St. Oakland 12 Calif
Industrial Indemnity Co. 350 Sansome St. San Francisco Calif
Argonaut
American
Insurance Co. 550 California St. San Francisco Calif
Motorists Insurance Co. 417 Montgomery St. San Francisco
California
:
a 2IA 5298222IA 529822
tok 22
Kilt 22
2
fl-
fl -fl - 2
2 29
General Accident Fire & Life Insurance Corp. Ltd.
600 California St. San Francisco Calif
United States Fidelity & Guarantee Co. 444 California St.
San Francisco Calif
Associated Indemnity Corp. 332 Pine St. San Francisco Calif
CalifonCiaalifonia St Continental Casualty Co. 433 Califonia
Aetna Casualty & Surety Co.
Califonia
Mey
San Francisco
ats,
Calif
Calif
American Employers Insurance Co. Rusa Bldg San Francisco Calif
Hanna and Brophy 1540 San Pablo Ave. Oakland 12 Calif
Henry G. Sanford Sedgwick Detert
714 Hobart Bldg San Francisco Calif
100 St. Moran & Arnold
121
Buch
Pine V.
San Francisco
Calif
fl-
EVERINT ALLEN R. NA
1946-1963
/
AGE
M
SEX
Asbestosis
INJURY SUSTAINED
HEAD OFFICE
COMPANY PLANT DIVISION
200- 8975
CLAIM NUMBER
OCCUPATION
~ C
bet sk >
27
Fo
Ta LAIM NUMIEN NUMIEN
ACENCY
PART OF BODY INJURED
AGENCY PART
U MECHANICAL CONDITION ADO'L INFORMATION
TYPE OF Accident
0/5 PERSONAL FACTOR
IAC 63 OAK 11139
FORM 853-305 9-42
FB050334
^'
DPLOTER EVER TT ALLENK ALLENK IAC
63 K 11139
FLANT 1946-19619346-1963 1946-1963 1946-1963 1946-1963 1946-1963
CL :
206-8975 206-206-897582906-789575
C Rate A
E
HRLY WAGE A
OCC A
INJURY
AcherTi
AcherTAicherTi AcherTi
AcherTi
AVO WKLY WAGE
ERS WEEK
: TERMINATION
COMP PAID
LOST TIME - : ABSENTER RECORD PLANT MEDICAL RECORDE PLANT PERSONNEL RECORDS PRIOR IED ACC
CH ID CLAIMS
@1 ctane:
IAC PRIOR CLAIMS & RATINGS DIARI
IMPO TO R.B. JR
RAYB
MED EXAMS
REFORE THE WOFIMENS COMPENSATION APPEALS BOARD OF OF STATE OF CALIFORNIA
Chaim 63 Dak 11139
| LE
,
ALIKH EVERITT
)
)
VLATREN ASHISTORY ASHISTORY 6
}
INSURANCE STATE COMPENSA IN INSURANCE FOND
FRAL ACCIELLT WIRE & ITE
)
ASSURANCE CORDOPATION LTD et al
~_
Defendanta
NOTICE OF TIME AND PLACE OF
NOTICE TO ALL PARTIES
You are hereby notified that further hearing will be held in the above entitled action at
March 21 1966
3000 State Building llll Jackson Street Oakland California
Apportionment of Liablant
1:30 P.M.
Before Referee Hicksan
2 Hours
+
7
7
Pad
Dan
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1500
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that it
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cyfrently cyfrently
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Gen lice Fon & Life Assuranc sp^/t~-slp^/t~-l
FB054113
_/
RECEIVED MAY 2S 1965
CORPOIRNAS DTEE PT
360 GRand avENUE , Danland DanlanC d AL CAL FO
STATE
6 9680 + TEL 46.4808 COMPENSATION INSURANCE
FUND
May 26 1965
TA REPLY BEFLA TO
A02967
Allen Everitt
Industrial Accident Commission Room 3000 State Building llll Jackson Street
Oakland California
Re
Allen Everitt vs. Western Asbestos Company and State
Compensation Insurance Fund et al I.A.C. 63 OAK 11139
Gentlemen
It is respectfully requested that the aforementioned case
be set for hearing to determine what if any apportionment
defendants Western Asbestos Company and State Compensation Insurance Fund are entitled to from the other defendants
to the aforementioned action
Very truly yours
Charles o Charles M. McMillan
<
Attorney
c
Smith Parrish Paduck & Clancy
Financial Center Building
Oakland 12 California
C - Henry G. Sanford 714 Hobart Building San Francisco California
FB054114
2
=.
Industrial Accident Commission
May 26 1965
C - Sedgwick Detert Moran & Arnold 100 Bush Street San Francisco
C - Hanna & Srophy 1540 San Pablo Oakland
C - Insulation & Asbestos Ind Works of N. Cal Vac Trust Fund Local
No. 16 200 Guernero St. San Francisco 3 Calif
c - Armstrong Cork Co. Liberty & Charlotte Sts Lancaster Penn
C - Armstrong Contracting & Supply Corp. 120 N. Lime Street Lancaster Penn
- Charles Ayres Co. 374 Brannan Street
San Francisco 7 Calif
.
e - Charles Ayres Supply Co. Inc. 698 Minnesota Street San Francisco 7 Calif
c - Harold G. Lorentzen Lorentzen Company 1155 Fifth Street Oakland California
c - Mundet Cork Corp. 2101 Tonnelle Ave.
N. Bergen New Jersey
C - Owens Corning Fiberglas
International F.S.
Subsidiary of Owens
Corning Fiberglas Corp. P. O. Box 901
Toledo 1 Ohio
,
C - The E. J. Bartells Co.
1212 Sixth Ave. S. Seattle 4
.
" C. F. Braun & Co. 1000 S. Fremont Ave.
C - Plant Asbestos Co.
1300 - 64th Street Emeryville Oakland 8 Calif
Alhambra Calif
c - The Philip Cary Mfg Co. Lockland Cincinnati 15 Ohio
C - Thorpe Insulation Co. 2741 S. Yates Ave. Los Angeles 22 Calif
- Standard Accident Ins Co.
- Thomas C. Douglass Jr.
433 Calif St.
Douglass Insulation Co.
San Francisco Calif
2233 Ingalls Street
San Francisco 24 Calif
- Employers Mutual Liability
C - Fibreboard Paper Products / Corp
Insurance Co. of Wis
114 Sansome Street
1789 Montgomery Street
San Francisco 4 Calif
San Francisco 11 Calif
C - Travelers Insurance Co.
-
Fluor Maintenance Inc.
P. O. Box 791 406 Ward
Martinez California
St.
1956 Webster St. Oakland 12 California
- Fluor Maintenance Inc. Box 7030 2500 E. Washington E. Los Angeles 22 Calif
c - Industrial Indemnity Co. 350 Sansome Street San Francisco Calif
- Argonaut Insurance Co. 550 California Street
San Francisco Calif
FB054115
-3Industrial Accident Commission
C - American Motorists Ins Co.
417 Montgomery St. San Francisco 4 Calif
- General Accident Fire & Life Insurance Corp. Ltd. 600 California St.
San Francisco Calif
C - United States Fidelity & Guarantee Co. 444 California St. San Francisco Calif
C - Associated Indemnity Corp. 332 Pine Street San Francisco Calif
-
Continental Casualty Co. 433 California St. San Francisco Calif
C - Aetna Casualty & Surety Co. 1330 Broadway Oakland Calif
C - American Employers Insurance Co. Russ Building San Francisco Calif
May 26 1965
FB054116
.
EMPLE INUPANUPANGGED EUPADNGED INSURANCE STATE
A02967 A02967
Aller E.
T eer .
sete. B.S
ls
ot
tern Ascestos Company
Stance Pind I.A.0.63 I.A.0.63 CAK
and liste
213- 213-
n-
roomt cf R. T. Read Superintendent Under-
:
soins
..f rnie Inspection Rating Bureau signed
BR. Besverar. .
to February 17 1964
re
o.oo of the petit has been mailed to al parties listed
{
a
-e@c
truly yours
Charles M. Attorney
McMillan
& Clancy Attorneys at Law 315 Bing Oakland 12 California
Surety Company 1330 Broadway Oakland
Insurance
we,
032
Company
Rusa Building
Insurance Company
omta
417 Montgomery Street
lirp . 32 Pine Street San Francisco
FB054117
8 Compensation Insurance Pund Industrial Accident Commission
Continental Casualty Company 433 California Street
San Francisco California
Pibreboard Paper Products Corp. 1789 Montgomery Street
San Francisco 11 California
Fireman's Pund Insurance Company 3333 California Street
Sar Francisco California
:
Fluor Maintenance Inc. P. C. Box 791 406 Ward Street
Martinez Californie
General
Accident
Pire
and Life Insurance Corp. Ltd.
San Fr ancisco California
and AstestoAsstestos Industrial Works of Northern
Ve con Trust Pund Local No. 16 200 Guernerc
a
re
:
Is 5. California . Company A Corporation 741 South Yates
Avenue Avenue Los Angeles Angeles 22 California
United United United States Pidelity and Guarantee Company 120 Montgomery
ArgoSntaruettArgonaut Street San Francisco California Argonaut Insurance Company 550 California San Prancisco California
Street
Employers Mutual Liability Liability Insurance Company of Wisconsin
Employers Sansome Street San Francisco 4 California
industrial Indemnity Indemnity Company 350 Sansome Street
San Francisco California
Standard Accident Insurance Company 433 California
San Francisco California
Street
Travelers Insurance Company 1956 bster Street Oakland
12 California
FB054118
Oo i OE
vy... ~
woe
ALIFORN A
RATE INSPECTION 1435 MI N STREET
SAN FRANCISCA FRANCISCA
CALIFORNIA CALIFORNIA
G BUREAU
34. AUSIMAI AUSIMAI ORIEN
ANATOLENE ANATOLENE HAVEY
4. H. KOPK38 ACTUANY
February 17 1964
PLATANANDUIS PLATANANDUIS PLATANANDUIS
ATTENTION
Compensation State
Compensation Insurance Fund
Gentlemen
This acknowledges receipt of your January 7 1954 letter questing Workmen's Compensation coverage information for the below
ed entities
re-
list-
The Bureau wishes to apologize for the lengthy delay in answering your requestbut certain files nad to be located
Coverage information is as follows
, Armstrong Cork Company
Standard Accident Ins
Co.
Policy No.
AZ 718480
1-1-51
Armstrong Contracting & Supply Corp.
Travelers Insurance Co. Folicy No.
,
Charles Ayers Co. - No records
RUB 7226992
RUB 7595409
1-1-58 1-1-59
Charles Ayers Supply Co. Inc. - No records
The E. J. Bartells Company
Emplys Mut Li0a1 b Ins Co. Policy No. 2312-02-025772 1-1-61
2313-02-025772 1-1-62
C. F. Bratz & Co. A Corp.
American Mo1t-- or Ins Co. Policy No. 7CM 426012 1-1-57 8CM 426012 1-1-58
/ The Philip Cary Mfg
prior
No No records recorrecodrds s prior to 1-1-1-15-57 7
RECEIVED
FB054119
FEB 19 1954 OAK LEGAL
FY
State Compensation Ins
Oakland 10 California
Puz^
February 27 General File Page No. 2
196
Douglass Insulation Co. - No records
Fiberboard Paper Products Corp. - Self Assured
Fluor Maintenence Maintenence Inc.
Continentai Casualty Co. PolicyNo. 1907635 4-25-55
.
Maintenance Filor
Ins
Continental Casualty Co. Policy No. 1894526 4-25-58
& Insulation Asbestos Industry Works of North Calif - No records
Harold G.
Lorentzen Industrial
Lorentzen
Indemnity
Indemnity
Co.
Co.
It
It
156 00429 Policy No. Policy aa
00 100019 1-1-5~
"
CC 600009 1-1-571-1-57
CC 600054 1-1-59
Xander Cork Corp.
Aetna Cas & Surety Co. Policy No. 21655-6-7 12-31-51
1
10 23413 PF 12-31-60
"
11
10 33764 PT 12-31-61
- Owens Corning Fiberglas
Aetna Cas & Sur. ety Co. Policy No. 310 733 RR 9-1-54
310 784 93 9-1-55
*
"
'
27 310 879 RR
9-1-57 58
41
1
310 926 RF PT 9-1-58
31
.
310 985 FR PT 9-1-59
11
11
20 2951 HR PT 9-1-60
Plact Asbestos Co.
No records prior to 10-1-39
Industrial
Indemnity
" 11 11 "
Co.
Policy No.
" ...
11 11
501 CP 00546 1-1-55
CP 100654 1-1-56
CP 608056 1-1-59
CC 600091 1-1-60
CC 611154 1-1-61
CC 61154 1-1-61
'
Thorpe Insulation Co. Fireman's Fund Ins Co. Policy No. WCP 3501 10-1-54
FB054120
RECEIVED FEB 19 1954
OAK LEGAL
State Compensation Insurance Find Oakland 10 California
February 17 General File Page No. 3
1964
Buck's Supply Company - No records
Very try yours
R. T. R. T. T. Read Superintendent UnderwritUindnegrwriting Underwriting Department
RECEIVED OAK LEGAL
ro]
3@
Ancan
Ancan
Ancan
112 PINE SIBEET SAN FRANCISCO * o>
rote
Industrial Accident 1111 Jackson Street
land California
Comission
Comission
Centlemen
We have received a cog of the and Insurance Carriers in the ww:
application has been received und
Grewer
The petition of the State Compen Ashistos Ashistos Company allees that th
was the carrier for the Fluor 'x.
of our records tenance ceased
indicates that any
on April 25 1953
Associated Indemnity Corporation
CA
De
.
Som 1
.
the
,
:
cy ben:
Incu
nee Fun and Wester
i
Twig Twig Twig Corporation
ee,pr in 1955
review
Soy
And for Fluor (zi -
not 2 joined in this action
.
+
GES ki
WAN WAN INSURANCE COMPANT
NEWARE
TH Ape MNbOS Tale IWE INSURANCE COMPANY
NEWABE
EMPLOYEE INSURANCE INSURANCE
FB054122
TOMOBILE TOMOBILE
a a
ASSOCIATED INDEMNA
COP OLATION COPPOLACOTPPOILAOTINON
SAN RANDOSCO
Stendal Accident Insurance Insurance Company Company 433 California Street
San Francisco California
Maple ps Mutual Liility Liility
Insurance co of Wisconsin
114
insome Str.et Str.et
San Tncisco Tncisco California
Tags Insurance Co.
1956 Webster Str et
Oakland 10 California California
General Accident Fire and Life Insurance Corp. Ltd.
600 California Strest
San Francisco California
United States Fidelity & Tuarantee Company 170
444 California Street Mu ~
Sen Francisco California
es,
Continental Casualty Co. 433 California Street San Francisco California
Aetna Casualty and Surety Co. 1330 Broadway Oakland California
State Compensation Insurance
Pand
525 Golden Gate Avenue San Francisco 1 Califorria
Flow instance
0 9s 791
*
:
Street
Him Califor
Inc. ia
Vota D> orists Insur
21
...
se
se
neit
St L 4 California
Company
2
we
m2
ver
.
g
Th
: Califomia
Me
Fireman's Fund In ur nce Coury Coury
3000 California Strict Strict San Francisco Californiz Californiz
Caliano
Iris Paduk tion ' Low
rnd
Clan
Tinancial
Center h^/leing
12 California
Fibrebodaper Fibrebodaper Products
1769 Montpery Montpery Street
San Francisco California
FB054123
February 1 1981
Industrial Accident Comdssion 1111 Jackson Street
Oakland California
Gentlemen
750
Allen Everitt Industrial Sccident Commission
Case No. 63 OAK 11139
We have received a cony of the Petition to Join Additional Employers and Insurance Carriers together with the Social Security records of Allen " Everitt Industrial Accident Commission Case No. 63 QAX 11139 but have not received a copy of the application We are therefore unable to file an Answer
In any event the Social Security records show earnings paid by us as amounting to only 80,00 de submit that the application should
be dismissed as de mininis in so far as this company is concerned
Very truly yours
PIEREBOARD PATER PRODUCTS COPPORATION
DB
ees
D. Hanson Manager ^fin loyeeInsurance Denartment
Standard Accident Imurance Company
433 California Street San Francisco California
Industrial Indemnity Co. 350 Sansame Street San Francisco Califomia
Employers Mutual Liability
Insurance Co. of Wis 114 Sansone Street
San Francisco California
Travelers Insurance Co. 1956 Webster Street Oakland 12 California
Argonaut Insurance Co. 550 California Street
San Francisco California
,
American Notariato Insurance Company
417 Montgomery Strent
San Francis 4 California FB054124
i
General ccident fire and Life Insurance Com Ltd.
500 California Street
San Francisco California California
United States Fidelity &
Quarantee urany urany hhh Califormis Street
San Francisco California
Associated Ilemnity Ilemnity Corn 332 Pine Street San Francisco California
Continental Casualty Co. L33 Califomia Street San Francisco California
Aetna Casualty and Surety Company
1330 Broadway Oakland California
American cloyers Insurance Camany
Tuss Building San Francisco Californiy
Fireman's Pand Insurance Cammany
3333 California Strent San Francisco California
Smith Parrish Paduk and Clancy
Attorneys at Law 315 Financial Center Building Oakland 12 California
3156
DEPARTMENT OF
HEALTH EDUCATION AND WELFARE
SOCIAL SECURITY ADMINISTRATION
PAYMENT CENTER
BABLTAILMTORIEMORE 45. 45. MARTLAND MARTLMAARTLN ANDD
State Compensation
Insurance Fund
525 Golden Gate Avenue San Francisco 1 California
Attention Mr. David S. Bloxsom Claims Adjustar
A0247
A0247
A0247 A0247 A0247 A0247
OCT 451952 451952
IN ACELVRETC ACELVRETC
ACELVRETC Account 14 PC7
503-03-5111
A. R. Everitt
Your reference A02967 Allen Everitt
Le th
IN
IN
1964
1964
EMP GYEE INSURANCE
Gentlemen
Mr. Allen R. Everitt social security number 503-03-5111 has
authorized us to send you the detailed information from liis carn-
ings record for the period January 1 1937 through March 31 1963
Employer Name
ti. Address
Period Ended
Amount
John Morrell and Co.
Ottuna Iotra
6/30/37 <
$ 174.11
Fontle Brothers Inc.
7. 117-119 S. Phillips Ave.
>
.Sioux Falls South Dakota
12/31/38 x
$
72.00
. +
Fantle Brothers Inc.
Chicago Bridge end Iron Co.
1305 W. 105th St. Chicago Illinois
3/31/39 9/30/11 x
$
75.00
$ 175.20
Parker Transfer and Storage
. W. Parker
221 ,
S. First Ave.
,
Sioux Falls South Dakota
12/31/412 12/31/412
9.35
i.
wy
Ko) .
Charles H. Rue
Rue Contracting Co. 515 14th St. N. Fargo North Dakota
9/30/42 x
$ 107.56
., vy Walter Butler Co. Atbol Idaho
9/30/42
214.20
A FB054126
Employer Name
and Address
.
. 7 > |
Enterprise Engine and Foundry Co.
600 Florida St.
San Francisco California
Northwestern X
Engineering Co. Rapid City South Dakota
Moore Roberts Freetly
Carrico and Gantier Maine and Washoe Sts
Richmond California
.
az
~ j
f \ ~ ..
ot
Kaiser Alexinem
and Chemical Corp. / G. F. Fennington 1924 Broadway Kaiser Bldg Oakl 12 California
Daniels and Turnquist
6CL Orpheum Bldg Seattle Washington
Kaiser Aluminum
4
and Chemical Corp.
ea / G. F. Fennington
J Ernest and Kaiser and Assoc Joint Venture 8825 Olympic Blvd. Beverly Hills Californis
Kaiser Kaiser Aluminum and Chemical Corp.
c G. F. Fennington
Sioux Falls Machine Works
. 47, 214 N. Dakota Ave.
+7 Sioux Falls South Dakota
Package Delivery Co.
iva 410 E. 12th St. Sioux Falls South Dakota
Period Ended
9/30/12
9/30/22 v 9/30/22
9/30/42
9/30/42 + 43 / 6/30/13 v 6/30/23 <
9/30/44 '
9/30/44
6/30/241 14 /
Amount
oe!
$ 41.00
2.48 7.91
114.95 800.85 800.85
32.38
853.23 61.11
192.19
582.00
890.22
33.25
124.63
RECEIVED RECEIVED 1963
NOVNOV
B
"
FB054127
Employer Name
and Address
+ Kaiser Aluminu
r
and Chemical Corp.
/ G. F. Fearington
_- Western Asbestos Co.
uy y
Box 3784
Rincon Annex
San Francisco 19 California
~ Western Asbestos Co.
"
Fibreboard Paper Products Corp. 1769 Montgomery St.
_ San Francisco 11 California
Western Asbestos Co.
ae
4
^ L Western Asbestos Co.
Period Ended
3/31/451 3/31/451
*
6/30/25
9/30/45 ,
30 /
9/30/46 9/30/46 <
6/30/47 6/30/47 ,
9/30/471
9/30/471
12/31/47 ,
12/31/174
18/ / 6/30/28 ' 9/30/18 12/31/48
19
Western Asbestos Co. 4
+ Western ^ sbestosCo.
A rmstrong Cork Co.
Liberty and Charlotte Sta Lancaster Pennsylvania
Charles Ayres Charles Ayres Co. 374 Brannan St. San Francisco 7 California
1-
Western Asbestos Co. \
12/31/504 9/30/50K 12/31/504 3/31/51' 6/30/519/30/51 9/30/511 30
51x
52
6/30/52 X
9/30/52
12/31/52
Amount
$ 798.06 814.20 814.20 316.80 316.80
$ 138.60 761.18
$ 922.20
944.00 944.00
916.65
20.00
$ 932.70 760.00 992.16 315.14
802.08 1,110.21
454.94
$ 943.75 1,120.00
4
~~ A
f
Employer Name and Address
Plent Asbestos Co.
1300 64th St.
Emeryville 8 California
"
Charles Ayres Supply Co. Inc.
- 698 Minnesota St. San Francisco 7 California
,
Mundet Cork Corp.
Y % D>, 2101 Tonnelle ive
North Bergen New Jersey
sp Western Asbestos Co.
+ 7Western ^ sbestosCo.
4 ut
} Western Asbestos Co.
f v, Plant Asbestos Co.
. Charles Ayres Co.
!. 698 Minnesota St. ~V~ San Francisco 7 California
21
X
Fluor Maintenance Inc.
O. O. Box 791
406 Ward St.
Martinez California
Y.
HaroHlarold HaroldG. Lorentzen
HaroldLorentzen Co. 1155 Fifth St.
Oakland California
Thorpe Insulation Co.
.
Corp.
2741 S. Iates ive
X2741 % Los Angeles 22 California
Period Ended
3/31/52 x
3/32/52 X
3/31/52 x
3/31/53
6/30/53 9/30/53 .
3/31/54
6/30/54
9/30/54
32
6/30/55
6/30/55 ' 6/30/55
12/31/55 }
9/30/55
9/30/55 ~ 12/31/55 y
9/30/555
Amount
$ 422.01
289.52
325.72
$ 1,261.50
1,664.05 673.90 $ 1,378.60
1,482,30
739.10
$ 1,471.05
176.40 176.40
100.80 529.20
50.80
126.00
247.66 429.80
208.00
_
F8054129
Employer Name
and Address
*
Owens Corning Fibergles
_y International P. S. Subsidiary
of Owens
Corning Fiberglas Corp.
P. Box 901 Toledo 1 Ohio
Period Ended
9/30/55 x
;
" Thos C. Douglass Jr.
X
Douglass Insulation Co.
X
Francisco 2233
San
Ingalls St.
2h California
X17 X17 X17 Plant Asbestos Co.
30 Harold G. Lorentzen
30
Lorentzen Co.
X41 X41X41 X41 Owens Corning Fiberglas International F S. Subsidiary of Owens
Corning Fiberglas Corp.
9/30/5~5
56- 3/31/5656-
56-
9/30/56.
12/31/56
12/31/56^ 3/30/56~%
Insulation and Asbestos
ay
Industry Works
of North California
Y Local ~ Vacation Trust Fund 200 Onernare St.
No. 26
San Francisco 3 California
7
Lockland + 1313
Philip Gary Mfg Co.
Cincinnati 15 Ohio
X28 Western Asbestos Co. Co.
X28
" - Harold G. Lorentsen Lorentsen Co.
56/
12/31/56 12/31/56
3 57
6/30/57
12/31/574
3/32/57
Amount $ 115.80
330.20
$ 298.15 1,600.20 1,773.90 373.35 14.10 203.20
52.50
740.15
$ 134.00 1,670.26 1,226.20
989.40 989.40
FB054130
Employer Name
Period Ended
C. F. Braun and Co.
10
Corp.
.
wo 1000 S. Fremont Ave.
Alhambra California
v
Phillip Nead and Shirley Nielsen
Industrial Insulation Co.
YESYES YES Warner
Cupertino California
57X 57X
3/32/574
bh 6 Western Asbestos Co.
x Charles Ayres Co.
30 58X
9/30/58 - 12/31/581
Owens ye
Corning Fiberglas
4 x International F. S. Subsidiary of Owens
Corning Fiberglas Corp.
58- 58-
9/30/58
+ 11 c.1 F. Braun and Co. Corp.
Insulator and Asbestos Industry
+ . of North California
?/
and Local Union No. 16
} Vacation Plan 200 Guerrero St.
San Francisco California
58- 32 58-
9/30/581
ya
f Armstrong Contracting
and Supply Corp.
120
Lancaster Ponnaylvania
a, Fluor Maintenance Inc.
.
Box 7030
;
2500 B. Washington
East Los Angeles 22 California
12/31/58
12/31/584
BY Western Asbestos Co.
Z
XY Plant Asbestos Co.
3/31/59 9/30/59 59x 59x
Amount
$ 554.80
85.25
$ 273.60 438.90 390.00 152.00
1,348.80
1,807.30 1,197.00
102.70
256.64
1,5022.,75052.651,502.75
284.93
180.60 180.60
rn
or
wees
FB054131
Prd
(
Employer Neme
and Address
32 Harold G. Lorentsen
}
Lorentsen Co.
;
Period Ended
3/32/59
Owens Corning Fiberglas
43 International F. S. Subsidiary
+
of Owens
Corning Fiberglas Corp.
12/31/59
3
Armstrong Contracting
and Supply Corp.
Il + Western ^ sbestosCo.
;
t D Plant Asbestos Co.
*
Owens Corning Fiberglas
International F. S. Subsidiary
Corning NG
of Owana
Corning Fiberglas Corp.
12/31/591
12/31/591
6/30/60
1122//3311//6600
12/31/60x
9/30/60 x
" t
'
Armstrong Contracting
and Supply Corp.
.
Wm Thomas Tuck
52 Sunshine Lane Tuck's Supply
^
Co.
Reno Nevada
} Western ^ sbastosCo.
Plant
52 Plant Asbestos Co.
X '-
< "Mundst Cork Corp.
}
The E. J. Bartalls Co. 1212 Sixth Ave. 5
Seattle 4 Washington
223323Western ^ sbestosCo.
33//3311/6/060 <
60f
.
3/32/61 6/30/61 ~
9/30/61 x 9/30/617
12/31/61 + 6/30/6162x
62x
3/32/62 9/30/621 12/31/62 J
Amount $ 160.00
1,637.25
336.00
$ 1,570.90 2,089.35
103.20 534.00
1,679.20 1,121.20
470,40 174.72
$ 2,135.40
1.077.55
291.20 113.52 400.40 182.00
1,857.68
(ncaseew
F8054132
~
~
8
Y 53 Flant Asbestos Co.
Mundet Cork Corp.
The E. J. Bartells Co.
X2 Wastern isbestos Co.
9/30/62 62X
6/30/62 4
3/31/63 v
$ 309.12
340.56
714.84 714.84
$ 1,676.68
We no recorer cod rd of any other earninfgosr the period in which
Mr. Everitt is interested
Workers began to acquire social security credite begiming 1937
therefore we have no record of any earnings for 1936
Our records do not show the amount of earnings in each quarter of 1937 because mployers were required to file reports only marios
that year
_
Any earnings earned after March 31 1963 have not been included Earnings are not usually posted to our records for at least 6 months
after the period in which the report is filed by the employer This inch time is needed to reosive and post the wage reports
Sincerely yours
Robert K. May
Chief
40792-1983 40792-1983 40792-1983
mo LEOAT
FB054133
1 2 3 & 5 8 7 8 g 10 10 11
11 12
13 13 14 14 15 15
16 16 122232 122232 122232 18
12 2 232
12 23 122222322
122232 122232 12 2 232
122232 12 23
122222322 25
N 27
N
N
31 32
BEFORE THE INDUSTRIAL ACCIDENT COMMISSION
OF THE STATE OF CALIFORNIA .
CLAIM NO 63 OAK 11139
are
ALLEN EVERITT
Applicant
VS.
WESTERN ASBESTOS COMPANY and STATE COMPENSATION
INSURANCE FUND Defendants
EMP OYEE INSURANCE INSURANCE
PETITION TO JOIN ADDITIONAL EMPLOYERS AND INSURANCE CARRIERS
TO THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OP CALIFORNIA PANEL ONE
Defendants Western Asbestos Company and State
Compensation Insurance Fund petition this Commission for an order directing that additional defendants be joined in this
matter because
1. Applicant Allen Everitt alleges that in the
period beginning 1946 and continuing through 1963 he developed
an occupational disease arising out of and in the course of
his employment
2. Applicant was in the employ of defendant Western
Asbestos Company for parts of the following quarters
6/30/46
9/30/46 6/30/47 9/30/47 12/31/47
6/6/3300//4488
9/30/48 12/31/48
3/31/49 6/30/49 9/30/49
9/30/50 12/31/50
3/31/51
6/30/51 9/30/51 6/30/52 9/30/52 12/31/52 3/31/53 6/30/53 9/30/53 3/31/54
6/30/54 9/30/54 3/31/55
6/30/55 3/31/57
6/30/57 9/30/57 12/31/57
6/30/58
6/6/3300//5599
9/30/59
3/6/3310//6600
9/30/60 12/31/60
3/6/3310//6611
9/30/61 3/31/62 9/30/62 12/31/62 3/31/63
and for no other time
F8054134
1
2
&
5 8
7 8
g
10 11 12
3. Defendants Western Asbestos Company and State Compensation Insurance Fund allege that all or part of applicant's alleged occupational disease if shown to have been the result of industrial causation arose out of and in the course of employment for employers other than defendant Western Asbestos Company and was wholly or partially contracted in the period beginning 1946 and continuing through 1963
4. Defendants Western Asbestos and State
Compensation Insurance Fund allege that applicant was employed by the following employers insured by the carriers indicated
as follows
13
;
14
EMPLOYER
INSURANCE CARRIER
QUARTER
15
A"rmstrong Cork Co.
Standard Accident
Liberty & Charlotte
Insuranoc Company
16
Lancaster Penn
433 California Street
San Francisco Calif
17
:
and
9/30/51 12/31/51
Employers Mutual Liability
18
Insurance Co. of Wis
114 Sansome Street
19
San Francisco 4 Calif
!*
20
Armstrong Contracting
and Supply Corp.
21
120 N. Lime Street
Lancaster Penn
Travelers Insurance Co.
1956 Webster Street Oakland 12 California
12/31/58 12/31/59
3/31/60
22
Charles Ayres Co.
| 23
374 Brannan Street
San Francisco 7 Cal
24
25
Industrial Indemnity Co. 350 Sansome Street San Francisco Calif
and
Argonaut Insurance Co. 550 California Street San Francisco Calif
26
Charles Ayres Supply
27
Company Inc.
698 Minnesota Street
28 | San Francisco 7 Cal
WN
Industrial Indemnity Co. \ 350 Sansome Street
San Francisco Calif
and
Argonaut Insurance Co. 550 California Street
San Francisco Calif
WN
The E. J. Bartells Co.
|
31
1212 Sixth Ave. S.
|
Employers Mutual Liability Insurance Co. of Wis
Seattle 4 Wash
I 114 Sansome Street
32
: San Francisco 4 Calif
12/31/51 9/30/58
12/31/58
36//3310//5525
12/31/55
6/30/61 9/30/61
2
FB054135
1
EMPLOYER
INSURANCE CARRIER
QUARTER
2 3 4 5 , 6 7 8 10
;
10
11 23
+ C. F. Braun & Company A Corporation
1000 S. Fremont Ave.
Alhambra California
American Motorists
Insurance Company 417 Montgomery Street San Francisco 4 Calif
J The Philip Cary Manufacturing
Lockland
Co.
Cincinnati 15 Onio
General Accident Fire and
Life Insurance Corp. Ltd.
600 California Street San Francisco Calif
Thomas C. Douglass Jr. United States Fidelity &
Douglass Insulation Co.
Guarantee Company
2233 Ingalls Street
444 California Street
San Francisco 24 Cal San Francisco Calif
F"ibreboard Paper
Products Corp.
1789 Montgomery Street San Francisco 11 Cal
insured
12/31/57 3/31/58 6/30/58
12/31/56
9/30/55
12/31/47
| 13 Fluor Maintenance Inc. Associated Indemnity Corp.
P. O. Box 791
332 Pine Street
14
406 Ward Street
San Francisco California
Martinez California
15
'
Fluor Maintenance Inc. Continental Casualty Co.
16
Box 7030
433 California Street
2500 E. Washington
San Francisco California
17
E. Los Angeles 22 Cal
9/30/55 12/31/58
18
19
i
20
Insulation & Asbestos Ind Works of N. Cal
Vac Trust Fund Local No. 16
200 Guernero Street
San Francisco 3 Cal
9/30/56 9/30/58
21
:
+ Harold G. Lorentzen
Industrial Indemnity Co.
9/30/55
.
N
Lorentzen Company
350 Sansome Street
12/31/55
1155 Fifth Street
San Francisco California
12/31/56
N
I
Oakland California
3/31/59
24 Mundet Cork Corp.
25 2101 Tonnelle Ave. N. Bergen New Jersey
Aetne Cesualty and Surety Company
1330 Broadway
3/31/52 12/31/61
3/31/62
N
Oakland California
N jv Owens Corning
Aetna Casualty and
9/30/55
N
Fiberglas International |: International F. S.
Surety Company 1330 Broadway
36//3300//5568
Subsidiary of Owens
Oakland California
9/30/58
N
Corning Fiberglas
12/31/59
Corp.
9/30/60
WW P. O. Box 901
t
Toledo 1 Ohio
:
| WW
32
3
FB054136
are: EMPLOYER
INSURANCE CARRIER
QUARTER
M
ee
uN
GG 7
8
0
1120
11 112 2 113 3 114 4 115 5
5656555
5655
5655655
5655
5625 0
N2N 1 NN
22NNNN
NNNN
N NNNNN
NNN2N6 2 2 8 8 229
3 3
332 2
Plant Asbestos Co.
1300 - 64th Street
Emeryville Oakland 8. Calif
ne
Industrial Indemnity Co.
'
350 Sansome Street
San Francisco California
and
American Employers Insurance Company
Russ Building San Francisco Calif
i
Thorpe Insulation Co. A Corporation
2741 S. Yates Ave. Los Angeles 22 Calif
FUND
FUND
FUND
3/31/52
6/30/55 2/31/53 6/30/56 9/30/35 12/31/55 9/30/59 12/31/60 9/30/61 9/30/62
9/309//5530/55
5. Defendants Western Asbestos Company and State Compensation Insurance Fund attach herewith as part of this petition a copy of the report of the Department of Health Education and Welfare Social Security Administration signed by Robert M. Mayne Chief that pertains to Mr. Allen Everitt's employment during the aforementioned time
WHEREFORE defendants Western Asbestos Company and State Compensation Insurance Fund respectfully pray that an order issue directing that the aforementioned employers and
insurance carriers be joined as defendants in this matter and granting all other and further relief that may be necessary and proper
Dated January 20 1964
CHARLES M. MCMILLAN
Attorney for Defendants
Western Asbestos Company State Compensation Insurance Fund
*
.
FB054137
we
PROOF OF SERVICE BY 1013a 2015.5 C.C.P.
) QQ
STATE OF CALIFORNIA
COUNTY OF ALAMEDA
M
aforesaid 5 I am a resident of the United States and a resident of the
F
aforesaid county
I am over the age of eighteen years and
not a party to the within above action my business address
is
3360 Grand Avenue Oakland 10 California
t On January , 1964 I served the within PETITION TO JOIN ADDITIONAL EMPLOYERS AND INSURANCE CARRIERS on the various
9
parties in said action by placing a true copy thereof en-
closed in a sealed envelope with postage thereon fully pre-
paid in the United States post office mail box at Elwood
and Grand Avenues in Oakland California addressed as follows
Armstrong Cork Company Liberty and Charlotte Streets Lancaster Pennsylvania
Standard Accident Insurance Company 433 California Street Son Francisco California
Employers Mutual Liability Insurance Company of Wisconsin 114 Sansome Street Son Francisco 4 California
Armstrong Contracting and Supply Corporation 120 North Lime Street Street Lancaster Pennsylvania
TravelrsTravelers Travelers Insurance California
Company
1956 Webster Street
Oakland 12
Charles Charles
Charles Charles
Charles
Ayres
California California California California California California
Company
374 Brannan Street
San Francisco 7
Industrial Indemnity Company 350 Sansome Street San Francisco
California
Argonaut Insurance Company 550 California Street San Francisco California
Charles Ayres Supply Company Inc. 698 Minnesota Street
San Francisco 7 California
The E. J. Bartells Company Washington
1212 Sixth Avenue
South Seattle 4
C. F. Braun and Company A Corporation 1000 South Fremont
Avenue Alhambra Californi
American Motorists
San Francisco 4
Insurance Company California
417 Montgomery Street
The Philip Cary Manufacturing Company Lockland Cincinnati 15
Ohio
General Accident 600 California
Fire and Life Insurance Corporation Street San Francisco California
Ltd.
Thomas C. Douglass Jr. Douglass Insulation Company 2233
Ingalls Street San Francisco 24 California -
United States Fidelity and Guarantee Company 444 California Street San Francisco California
Fibreboard Paper Products Corporation San Francisco 11 California
1789 Montgomery Street
Fluor Maintenance Inc. P. O. Box 791 406 Ward Street Martinez California
Associated Indemnity Corporation 332 Pine Street San Francisco California
FB054138
AW
&
Oo
a
10 11 12
Fluor Maintenance Inc. Box 7030 2500 East Washington Street East Los Angeles 22 California
Continental Casualty Company 433 California Street
San Francisco California
Insulation and Asbestos Industry Works of North California Vacation Trust Fund Local No. 16 200 Guernero Street San Francisco 3 California
Harold G. Lorentzen Lorentzen Company Oakland California
1155 Fifth Street
Mundet Cork Corporation 2101 Tonnelle Avenue North Bergen New Jersey
Aetna Casualty and Surety Company 1330 Broadway Oakland
California
Owens Corning Fiberglas International F. S. Subsidiary of Owens Corning Fiberglas Corporation P. O. Box 901 Toledo 1 Ohio
Plant Asbestos Company 1300 - 64th Street Emeryville Oakland 8 California
American Employers Insurance Company Russ Building San Francisco California
Thorpe Insulation Company A Corporation 2741 South Yates Avenue Los Angeles 22 California
I certify under penaltoyf perjury that the foregoing it
true and correct
15
Executed on January , 1964 at Oakland California
16
17 Jeanie L. Rucker
^
2
- Smith Parrish Paduck and Clancy
Attorneys at Law
20
315 Financial Center Building
Oakland 12 California
21
22
23
NN
25
26
27
2
2
2
The proof of service by mail form being signed under penalty of perjury does not require notarization
32
FB054139
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9.
EMPLOYMENT EMPLOYMENT BY YEAR
Tol
Betas LSD
q
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a a
-
~
- JOHN
OTTUMWA IOWA
MORROW fet _
-
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JOHN |
FANTLE -
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Raotiees
@ FANTLE
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,
IRON
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en a
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PARKER TRANSFER STORAGE 1305 DAK | STORAGE ee
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FARGO FARGO
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ee
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NORTHWESTERN ENGINE FOUNDRY 1600 NORTHWESTERN NORTHWESTERN SF @
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CHARLES
CHARLES
AYRES
LIBERTY CHAILLOTTE LAN 14 1% ..
CHARLES AYRES Co 374 BRANNAN , SF 7
ST.- ST.- ASBESTOSCo. 1300buSt T.- ENERYE
SF7 -
*. CHARLESSupplCyo Tue 698 MINNESOTA
MUNDET
CORP VOITONNELLE AVE
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-j WESTERN ASBESTOS Ce, . SF
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WESTERN ASBESTOS CO ASBESTOASBESTO CO '
|
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PLANT Em SUBSIDIARY DONGLASS THORPE
Co. FLVOR
SUBIDARY
FIBREGLAS INTL SF
SUBSIDIARY
IINSULANTION SULATION Co 2783. INGALLS ST SE pe ,
INSULATIOINSNULATION 2741 5. YATES AVE LA
MICE INC 406 WERD
ST, MARTINEZCA
1155-52 LORENTZEN LORENTZCEON
uv
"
1155-52 ST OPEN OPEN
.
Po
CHARLES AYRES CO 1..; | SF ,
i
-
-
;
OWENS CUIRNING FIBREGLAS
PLANT ASBESTas ASBESTas ASBESTas Co
-
U
te
.
49
SF SURE
f_m .- ..
The Pile CAREY MEG Co LOCKLAND Sayer et
LORENTZEN LORENTZEN C
PLANT ASBESTOS
OAKLAND
OAKLAND
Me
Em Em
1500 1500
INDUSTRIAL WARNER INSULATION INSULATION
INSULATION
CO11835
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CUPERTINO CUPERTINO CAUF
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WESTERN
:
ASBESTOS Co
Do.
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PERIOD PERIOD
|
Covered
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|
3-31-58- 3-31-58- 3-31-58-
180730 180730
7
6-30-58 6-30-58
1197
"
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