Document 3Q509wZyv7KZV9Edy3QRoNxYE

ST AT L OF CONNECTICUT) ) SS. Bridgeport COUNTY OF FAIRFIELD ) pxhibit#^! <?/f I ^!iy:W!V' Case # U.S. DISTRICT COURT EASTERN DISTRICT OF TENNESSEE C E RTIFICATION THIS IS TO CERTIFY that the attached is a true and accurate copy of the Agreement for Covenant not to Sue, Petition and Order from the records of the Office of Workmen's Compensation Commission, State of Connecticut, Fourth District, in the case of: John Gyana vs. Raybestos Company, now Raybestos-Manhattan, Inc. and The American Surety Co. of N.Y.; The Employers' Liability Assurance Corporation. Given under my hand and seal this 1978. m day o f /& uG ujf fOHfi A. ARCUDI, (orkmen's Compensation Commissioner :ourth District JOHN GYANA, CLAIMANT 202 Denver Avenue Bridgeport, Conn* t CORAUt I COMPENSATION COMMISSIONER RAYBESTOS COMPANY, now RAYBESTOS MANHATTAN,INC And Enployer l FOURTH CONGRESSIONAL DISTRICT I BRIDGIPORT , CONNECTICUT THE AMERICAN SURETY CO OF N.Y. I < THE EMPLOYERS* LIABILITY ASSURANCE CORPORATION I Insurer-Respondent* DECEMBER /J, 1939 AGRKWtfFMT TOR COVBiANT NOT TO SUB PETITION AND ORDER WHEREAS on or about the 12th day of February, 1938 and fc a number of years prior thereto, the olalmant, John Gyana, of Bridgeport, Connecticut, was an employe of the Raybestos Compan now Raybe&tos-Manhattan, Ino*, of Bridgeport, Connecticut and WHEREAS the said employe and employer had aocepted and were at all times mentioned herein subject to Part B of the Workmen*8 Compensation Act of the State of Connecticut, as amei and the employer had insured its liability thereunder For rarlc periods during whioh the said olalmant waB employed with The American Surety Company of New York and The Snploysrs* Liabilit Assurance Corporation, all of which said oompanies exist and da business under the laws of this State and are duly authorized t take suoh risks in this State, and WHEREAS the olalmant claims that on or about the 12th daj of February, 1938 he suffered an occupation disease, to witt Asbestosis, and further claims that said oooupational disease c out of end in the oourse of his employment with the employer} c further elaims that said disease is compensable; and further ol that he has been disabled from all work sinoe February 12,1938 and further oleins that he will be disabled in the future, ell whioh said claims each and all of said respondents deny, and WHEREAS a partial hearing of said claim was held before 1 Compensation Commissioner of Said Fourth Congressional Distrlol will more fully appear in the files of said office, and X DEC 12 P VHEBXAS, the said Jobs Oynaa has a wife, final#, ho la a potential dependent, and WHEREAS, the aeld elalaant was represented at the aforesaid hearing and la now represented by oounsel, and NHEBBA6 It la the desire of the claimant and the said Haybeatoe-Manhattan, Ino,. The American Surety Company of New Yoric and the Saployers9 Liability -Assurance Corporation, to reaoh an emioable adjustment of the above disputed olaims to the end that further litigation be avoided and doubtful and disputed oleins be rendered certain, THIS IS TO CEKTUT that I, the elalnant have agreed to receive front The American Surety Company of New York #1661,49 The Employers* Liability -insurance Corp. #36,91 i making a total sum of NINETEEN BUWRKD and No/100 Dollars, and ws the said Insurer respondents do agree to pay to the olalnant the bus above specified, to witi The Amerioan Surety Company of New Toxic #1861.49 The Jfaployers* Liability -Assuranoe Corp,, #38,51 In return for the following covenant not to aue#. or ,nv. further ola AND TO FURTHER CEBZIJT that In consideration of said suns so paid, I, the claimant, do hereby, now and forever covenant and agree not to make any further claim against, sue or molest the employer, Baybastos-Uonh&ttan, Ino., and all the insurer respondent! above nemed, to wit! The American Surety Company of New York and The Employers* Liability Assuranoe Corporation, upon and as to said emp loyer and said insurer respondents, only, to forthwith dismiss any end all such claims, suits or proceedings for compensation benefits, whether for compensation In any Ibra payable to me under said Aot or for surgical, medical or hospital benefits payable on my behalf and whether said claims have already arisen or hereafter might arise by reason of aforesaid claim for occupational disease and to forever refrain from instituting, pressing, collecting, or in any way aiding or proceeding upon eny and all claims, demands, causes of aotion, suits, proceedings or adjudications whatever which I ever 2- bore bad, now bare or nay h*v* against the employer and all said Insurance respondents by virtue of said aforesaid claim for compensation benefits arising out of said occupational disease, ti wltt A3BSST0SIS. AND I, Susie Cyana, wife of the aforesaid claimant John Qyana, do agree that In consideration of said sums so paid do hereby* now and forever covenant and agree not to make any further claim against, sue or molest the employer and the said insurer respondent# above named, only, to forthwith dismiss any and all suits, olaims and proceedings for compensation benefits in any form payable to me under said lot by virtue of said claim of an occupational disease by the said John Oyana while in the employe of the said employer respondents, who are parties to this agreement It is hereby expressly understood and agreed that these presents may be pleaded by the ?nployer and said insurer respondent referred to above, only, in bar of all suits or other proceedings whatever hereafter pending against the employer and said insurer respondents In breach of this covenant. It Is expressly understood and agreed that this instrument Is not Intended as a release or discharge of, nor as an aocord of satisfaction with any other person whomsoever, but only as a covenant not to make any further olaim against, an sue, and to the affect that the employer, &aybestoe-Manhatta&,Xne, and said American Surety Company of Hew Toik and Employers* Liability Assurance Corporation, insurer respondents, purchase peaee and ere hereby given peace upon any and all claims and matters whatsoever and more particularly, said claim lbr compensation ibr occupational disease, to wit: Asbestos!e, herein referred to. That we, the claimant and said respondents hereby submit the written agreement to the Compensation Commissioner of the fourth Congressional Dietriot and respeotfully ask that said agreement be approved. It is also understood and agreed that*no subrogation on the part of the Kaybestos-Manhattan, Ino, The American Surety Company of New York or The Employers* Liability Assuranoe Coxp., will be made against any monies collected by the Claims* *----------- Company, Tha filaok Book Maohins Shop or the ^rane Taira CaBpa&7< Za aitam thereof n hereunto sat our hands tha day and data first abara written* Claimant Potential Claimant. Wife. RATBEST03 COMPANY now THE AMERICAN SUBETY CO. OF HEW YORK EMPLOYERS*LIABILITY ASSURANCE CORP. Apr--------- * /c~* ---------- - -929 Compensation Commissioner Fourth Congressional Distriot*