Document 88jK8yEY4LKw3Vb50RZKEvvm

PLAINTIFF'S EXHIBIT I e>V3ftO. Zj ' STATE OF CONNECTICUT) ) SS. Bridgeport COUNTY OF FAIRFIELD ) fBWb* \9Z3 | j:Cse# """"" U.S. DISTRICT COURT l EASTERN DISTRICT OF TENNESSEE c E RTIFICATION THIS IS TO CERTIFY that the attached is a true and accurate copy of the Agreement to Compromise, Petition to Compromise and Order from the records of the Office of Workmen's Compensation Commission, State of Connecticut, Fourth District, in the case of: Pasquale Crocco vs. Raybestos Company, now Raybestos-Manhattan, Inc. and The Travelers Insurance Company; The Hartford Accident and Indemnity Company, The American Surety Co. of N.Y.; The Employers' Liability Assurance Corporation. Given under my hand and seal this 1978. JOHN A. ARCUDI, Workmen's Compensation Commissioner fourth District PLAINTIFF'S EXHIBIT PASQUALE CROCCO, 16 Oak Ave. Milford, Conn.j * . * .`or ! CLAIMANT . :;ir VS,.-, RAYBESTOS COliPANY now RAYBESTOS-MAHHATTAN, INC. ' EMPLOYER AND ' -.ftiil District * t CORAMUt , . ..v.....,......".'. .c..l *............ . . . { ..... ' COMPENSATION COMMISSIONER 5--, l.o v*\*4` - f. '< * r , S FOURTH CONGRESSIONAL DI8T. BRIDGEPORT, CONNECTICUT THE TRAVELERS INSURANCE CO. '' /T," THE HARTFORD ACCIDENT & INDEMNITY CO.J JULY / 0 , I94O. THE AMERICAN SURETY CO. OF NEW YORK....... THE EMPLOYERS' LIABILITY ASSURANCE CO.:.- INSURER-RESPONDENTS ` J -n t:r.. ,>fe0.4 AGREEMENT TO COMPROMISE CcV- ^: PETITION TO COMPROMISE AND . ORDER WHEREAS on or about the 50th day of April 1958 and for a num- -. - i V ** -- bars of yaara prior thereto, the claimant, Paaquala Crocoo of Milford Conn., was an employe of the Raybestos Company, now Raybestos* Manhattan, Inc. of Bridgeport, Conn, and ' '0 WHEREAS the aaid employe and employer had aooepted and were at all times herein mentioned subject to Part B of the Workmen's Vs i-.V;' l. .. i... . f. . Compensation Act pf. the State . of Connecticut, aa amended, and the employer had .insured lta liability thereunder for various periods during which said claimant was employed .with The Travelers Insurance Company, the. Hartford Accident and Indemnity Company, the Amerioan Surety Company, of New YTork and the Employers * Liability Assurance Corporation, all of which said companies ^ exist ^and do business under the laws of this. State and are duly, jauthorl zed .to take auch risks in this State, and. ra..,:.so. :ka: * .?. i 1 i 1. v > WHEREAS the claimant claims .that .on. or about January 15, 194 he became aware that he was. suffering .frommxx occupational disease, to wit: Aebestosis; and further claims that eald occupational disease arose out of and In the 0ourse of his employment with the ad d employer; and further claims that.s^id disease la compensable; and further claims h has been dieabled from all work since said January 15, 194; and further claims that he will be disabled in tbe future, all of which said olalms each and all of sd. d V. , . . respondent^ deny, and '' JMVS CHOCCO * crviitm : comm* Compensation Commissioner for the Fourth Congressional District as will more fully appear in the files of said office, and WHEREAS the said Pasquale Croooo has a wife, lfary, and seven minor children, to wit, Anthony, Michael, Leonard, Pasquale, Jr*, Mary Louise, Raymond and Ernest Croqco,..all of whoa are potential dependents, and* f is--. ' WHEREAS the said claimant was represented at .the afore aM. d hearing and Is now represented by.counsel, and ^ WHEREAS it is the desire of the .claimant and the sdd res pondents to reach an amicable adjustment.of the above disputed claims to the end that further litigation be avoided end doubtful and disputed claims be rendered oertain* THIS. IS TO CERTIFY that I, the olalmant, have agreed t re ceive from: . rl.... t ;-..f l o:' The Travelers Insurance Company-.. ..... * $3l+4*llf , The Hartford Aocident and Indemnity Co, 5&39h The American Surety Cp, of New York The Employers' Liability Assurance Corpy . 330*82 11.10 making a total sum of TWELVE HUNDRED FIFTY AND NO/lOO - - - DOLLARS and we the insurer respondents do agree to pay to the said clalman the sum above specified, to wit:. , t: - The Travelers Insurance Company 3M**l4 The Hartford Accident and Indemnity Co, The American Surety Company of New York ' The Employers' Liability Assuranoe Corp* 5^5*9l* vv . ; ' ;... . * ..'v;... .11,10 .. .. in full aocord and satisfaction of above disputed claims, AND TO FURTHER CERTIFY that in consideration of aald sums so paid, I, the claimant, do hereby remise, release and forever dis charge the employer and all the Insurer respondents from all clrf. ms for compensation benefits whether for opmpensatlon in any form payable to me under eald Aot or for surgical. , medicd. or hospital benefits payable on my behalf aridwhether said claims have already arisen or hereafter might arise by reason of the afore- aaidj claim of occupational disease, AND TO FURTHER CERTIFY that I, Mary Crocco, wife of aforesaid r .*. '? i. olalmant, Pasquale Crocco, do agree that in consideration of seld ji .*! J'* jub-ioaepTotf couw,T89fou1* loSt fp9 torn-pp c0P8t*aaToo-T Drs<PI,Icf sums so paid to rend.aa, release and forever dlaoharge each and all the above named respondents from any and all claims which I might hereafter have against any and all of them by reason of the alleged incurring of an occupational disease by the said Pas quale Crocoo while in the employ of the said employer-respondent. AND TO FURTHER CERTIFY that I, the claimant, Pasquale Crocco, as parent and natural guardian and next friend of aforesaid minor children, potential dependents, and I, Mary Crocco, wife of said Pasquale Crocco, potential dependent, and mother of aforesaid minor children, and potential dependents, do, in further consideration of said sums so paid, discharge each and all the above named res pondents from all claims which mlgjrt hereafter be made by them against any or all of the above named respondents by reason of the aforementioned alleged incurring of an occupational disease by the said Pasquale Crocoo, while in the employ of the above named employer-re spondent. AND TO FURTHER CERTIFY that we, the claimant and the respondents hereby submit the written agreement to the Compensation Commissioner of the Fourth Congressional District and respectfully ask that said agreement may be approved with the force of a full and final award. In witness thereof we hereunto set our hands the day and date first above written. o"Witne7ss d tness/ Lalmaht, parent, natural guardian and next friend of Anthony,Mlchael,Leonard, pasquale,Jr.,Mary Louise,Raymond and Ernest Crocco, potential claimants. ______________ Potential (^almant ana Parent RAYBESTOfPCOUPANY,HOW RAYBEST0S-MANHAT1 THE TRAVELERS INSURANCE COMPANY By: Approved this JH daT of July, 1940 7/i Compensation CommissionerFourth Congressional Dist, THE AMERICAN SURETY COMPANY OF NEW YOR! By: ____________ THE EMPLOYERS* LIABILITY ASSURANCE COR By: j/' q^C^h-C