Document DddVX1vrMmdL82q5xqJgQRYaa
Thompson & Knight
Attorneys and Counselors
Two Wahrenbehoeh House 208 West Foubteenth Street
Austin, Texas 73701 (512) 474-8211
2300 Republic National Bank Building Dallas, Texas 75201
(214) 655-7500 CABLE TOMTEX TELEX 73-2298 TELECOPIER: (214) 655-7569
Direct Dial:
(214)655- 7685
August 3/ 1982
Two Enehot Square Suite bso
4849 Greenville Avenue Dallas, Texas 75206 (214) 655-7500
Ms. Paula Shipp Johns-Manville Ken-Caryl Ranch P. 0. Box 5723 Denver, CO 80217
Re: Documents from the Industrial Accident Board
Dear Ms. Shipp:
I am enclosing copies of additional documents from the Industrial Accident Board per Jim Geiger's request.
Sincerely,
SKK/vb Enclosure
Sandra K. Kindle Legal Assistant
i
NOTICE THAT EMPLOYER HAS BECOME SUBSCRIBER
TEXAS WORKERS' COMPENSATION ACT
Notice i* he*edv given By the named employe* end the named tnauraoee company required Ov the TtiM Workers Compensation n*u*re a:t C^ecte* Ge#rai tews 191T and Amendments thereto, that the named employer net become e subscriber unde* satd Act end amendments tnemto end p*ovdni K'f *** Oeyment ot compensation to empiovett under the terms end proweions thereof Any employer or association wilfully tailing or refusing to t e m*s net ce s* v be liable tor end shall pay to the State ot Texas a penalty of not more than One Thousand Oolieie($1,000) for each offense
INSURANCE COMPANY SIGN HERE no sr' i'*-f orup namf
Ideal Mutuat-In
.NAVE OF INSUftANC
260 Madison Ai
gIiED: SIGNATURE HERE CONSTITUTES NOTICE ON BE HALF OF INSURANCE COMPANY
POLICY NUMBER: WCTQ-091,.---------------------------
71 NEW POLICY
X RENEWAL
effective- from 7/1/98------- to until_Canclld
Mriman Risk Minaaflatnti Xnc* D/B/A Arariikr Inc AGENCY WRITING THIS COVERAGE African **** wanag--___________ '-------------------------------------------
NAME
One Executive Driv, Port L--, MJ 07024
___________________________AOQPCS5
(201) 592-7100
IMMEDIATE PRIOR COVERAGE WAS IN EFFECT FOR PERIOD FROM
THROUGH (INS CO.) IMOT EOUHWD H MMHO M IX COMPAND
SCOPE OF COVERAGE:
3 ENTIRE STATE OF TEXAS (ALL OPERATIONS)
D PROPRIETOR ANtVOR EXECUTIVE OFFICERS INCLUOED .
NOTICE FOR DIVIDED RISK POLICIES COVERING SPECIFIC JOBS. JOINT VENTURES AND FOREIGN OPERATIONS MUST BE FILED ON I A 8. FORM 1S4 REINSTATEMENT REVOKES CANCELLATION
EFFECTIVE ________________________ ___________________________
OCCUPATION OF INSURED _______
PI--tic Good Mfg.
APPROXIMATE NUMBER OF EMPLOYEES _______ ESTIMATED ANNUAL PAYROLL____________
525 16,919,900
BELOW LIST PRINCIPAL CORPORATE NAME FIRST. GIVING HEAOOUARTERS AOORCS8. THEN UST EVERY SUMKXARV CORPORATION OOING BUSINESS IN TEXAS AMO PROVWC ITS PRINCIPAL TEXAS AOORESS. ALSO UST EVERY OPERATING OR DIVISIONAL NAME U8EO tN TEXAS ANO PROVWE THEM LOCATIONS CONTINUE UST ON SEPARATE SHEET ANO AT TACH
____ Johns Minvilli, CoreP.0. Bos S1P9 Qenvsr. Co 10211
mu or ffhtOM siowwo honcc
i DATE:
7/9/80-
! SIGNATURE HERE CONSTITUTES NOTICE ON BE*
| HALF OF EMPLOYER
I A 6 form tA*v eth
ORIGINAL COPY
JM * jjj
UMiroaM eetwTtwe e euepur otv. wests*
(MM
NOTICE THAT EMPLOYER HAS 8C0M SUBSCRIBER
f/AS workers ::a?r.K',noN ArT
r
/
* * *,-.*.
- V'#*^jrrpur.
r"'*
' ' ' * |W*0r. . . ,tvi ***'. .! *h
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; SIGNED|'
' SIGNATURE hcE CONSTITUTES NC'T'Cc ON BE j halt C .nsuRancl company
I j
POLICY NUMBER' ____VC 79-dQRJ____________
" NEW POLICY
x RENEWAL
EFFECTIVE FROM Wzs--to 7/i/sq
AGENCY WRITING THIS COVERAGE firm Sylvan Awmip, Pngl
___ARM IntpmaMrral Ttv-------' name
ri iff<a,- Mew Jersey-------------------------------------(2Ql)^87Wtpoi
VMED.A'E PRIOR COVERAGE WAS EFFECT FOR PER:OD FROM:TO'
hROuGh HNS CO I____________________ ________ ____________________ POUCY NUMBER: j inot requircd i* renewed in same tcuprnv
SCOPE OF COVERAGE
ENTIRE STATE OF TE.XAS (ALL OPERATIONS)
r PROPRIETOR AND'OR EXECUTIVE OFFICERS INCLUDED
N0*'CE RQR DIVIDED RISK POLICIES COVERING SPECIFIC
JOBS. JOINT VENTURES AND FOREIGN OPERATIONS MUST BE c,LED ON i A 0 FORM 154 Z REINSTATEMENT REVOKES CANCELLATION
effective
_________________________
OCCUPATION OF
insuredPlastic (Vnd Mfg
APPROXIMATE NUMBER
of employees ___________ 525__________ Estimate? annual
oavroll
______________ a,QQQ+QQQ
Se-OVt. wlST PRiNCIPAL CORPORATE NAME FIRST. GIVING if *OQUAPT6RS ADORESS. THEN LIST EVERT SUBSHXARV
( '>OaA*iON DO'NO BUSINESS N TEXAS AND PROVIDE ITS uo.NCrPA-. '*AS AOORESS ALSO LIST 6VERV OPfiRATtNG Cjo OiviSiCNAl name USED in TEXAS AND PROVIDE THEIR .0 at.qss CONTINUE LIST ON SEPARATE SHEET ANO AT
Johns. ManviUa Corp,---------P-0, tec 5108--------------------------Danwar-r- Ootorarto------ 80217
ORIGINAL COPY
z--mmr-m1
---------Jfif * 23--
UN.CM ftNINTlNft ft ftUftfttr
WC
NOTICE THAT EMPLOYER HAS BECOME SUBSCRIBER
flgQ 28
t&HAS WORRERS'^OMPEMSATION ACT
mm iwnniiwrtiimiind wmm--dmiincgiwio,wnoMOrNTtunnwrCi'' .urn am >iwh>i,C"mi nM.
Hit, m Mmncnwnc m. mm mnrwmwmioyir wt--nwmwcnem m>dm * mm mnpnawwnm if--mWHY
Wm
1 compmi--lnn t* mpKYPW unMr m* Mrm* An* cumin limt. An* mnpi*YW ec oownon wittii** Mf oc
ts i m PM* panne tM
coennaomipfP mtiwolTfi pnnm* m nm mow mm OooTftoinonaDoim (11.000 IOC pwc^onpp CO.
Ob 5693
INSURANCE COMPANY SION HERE
(CO NOT UM OAQIin NAiMI
TrraiT. MnrtTAT. marra^m wnmky HJJM or INSUMNCl CONMNT ON AESOOATWN
*h260 ttedl9n Ave.. W._
SIGNED: _ SIGNATURE &RE CONSTITUJ HALF OF INSURANCE COMPAR
NOTIG
BE-
POUCY NUMBER; WC 78-091
NEW POLICY
C RENEWAL
EFFECTIVE: FROM 7/1/78
TO 7/1/79
AGENCY WRITING THIS COVERAGE:
ARM International, Inc.
600 Sylvan Avenue. Englewood Cliff3. NJ
IMME0IATE PRIOR COVERAGE WAS IN EFFECT FOR PERIOD FROM:
(201) 871-0001
PHONE NUMBEP
. TO:.
THROUGH: (INS. CO.) {NOT REQUIBCO IF RENEWED IN SAME COMPANY)
, POLICY NUMBER: .
SCOPE OF COVERAGE
3 ENTIRE STATE OF TEXAS (ALL OPERATIONS)
3 PROPRIETOR AND/OR EXECUTIVE OFFICERS INCLUDED
NOTICE FOR 0IVI0E0 RISK POLICIES COVERING SPECIFIC JOBS. JOINT VENTURES AN0 FOREIGN OPERATIONS MUST BE FILED ON I A B. FORM 154 3 REINSTATEMENT: REVOKES CANCELLATION EFFECTIVE
OCCUPATION OF INSURED-_________PlagtiC Goods Mfq.
APPROXIMATE NUMBER OF EMPLOYEES ________
estimated annual
PAYROLL ___________
_125_ 8.000.000.
below
principal corporate name first giving
headquarters address then list every subsidiary
('ORPORAT-r-N DOING BUS`NCG" in TEXAS and PROViOE ITS
pm*NCiPAv tE*AS ADDRESS alSO 11ST EvfcPY OPERATING
OW DIVIS1ONA1 NAME USE0 'N TEA$ AND PRQviOt THfciR
LvCATON* CONTiNUfc LIST ON SEPARATE SHEET AND AT
TACH
Oemu4**
_______________
-J10, fit)*
.__CaX~ --I.OJL47-_________________
BOARD'S SVAMP
MU1- --
employer Sign here
signed.
// <> /-
iJ.fC. Curcner"
Insurance^ Manager T',lt'V- *TaSON SlaNi'ho Nv*rS*`
date
October 23, 1978
__ _
SIGNATURE HERE CONSTITUTES NOTICE ON BE HALF of employer
PljWUCE0 JM -j83L
L. i
t.'.tIXJr'SKkit-Sf -J'T--iXj j*v? A.tACil IO *Ti.Cl
NOTICE THAT EMPLOYER HAS BECOME SUBSCRIBER
't-Ai- AGRKtRS' COVlPtN..
*. *
ty *+* r> *tw* -'j **
r."v\'4*
5'* : jw'VMiwfVtUP
I
r-*nv ,i .j.rp--ot.vw'Tri s*;
j'kS#* tri* *J a:o> mc4'1** **v?*r^J *n P
^#*S*
.' K>'^S**** Ol T**M 1 0*0? *v C ffttMG< *-* 7
1 1
INSURANCE COMPANY SlCN MfertC
\ ,C'"
" * `.*W
!1
I
*
ti
I
IDEAL.MUTUAL.INSURANCE COMPANY
i ***' * "v " ,,C4"*S*; ' **c 'N* '
ym'
; NY...10QiD j
I S TO
'
. L* ijNA*uRl '-`cPe O.OnS'.Tl.,,,cS NC*Cc *-'N Be j
nA* ~ OF INSURANCE COMPANY
x.
|
pol'Cy number .HC..78=1/91
NEW POLICY
3S RENEWAL
1 1 13 1 73EFFECTIVE FROM JXA &... TO J * . --
4GRNCY writ,no this coverage
_ABM_Inernational,_Inc.... 4M-
6G0 Sylvan Avenue. Englewood Cliffs jNJ.,
V.Mtui -1
COvcPAGc .a$ * !: *
'CR PP<C 2 TRCM
. f201'> 871-0001 ______________ PWQNt SUMBEB_______ _
*0
:^OuC^ iNS CO r**OT tOUmE0 if RENEWED ** SAME CCMHkN*i
__ POLICY NUMBER
.Z2Sfc *r COVERAGE -- Christ SrA^c ~p TE*A5 .[ALL ^Ppp-TICNS*
: -SOP^'E'CP AND-OP EXECUTIVE OPFiCEPS INCLUDED
SC- ;6 -Sh 3-VtDED RISK POLICIES COVPwG SPECIFIC .;SE - JiN' vENTLPEl and FORE:GN OPePATfONS MUS? 3E r l r ` A B PORM 'c4
i: s .rA^/rsi REVOKES CANCELLAT*ON
BOARD'S STAMP
I'f 5
OCCUPATCN OF NSUPED ______
GiSfiSlSLU i&LiM 8WU
appc> vatl number cfi rMP-_C*EES _______ eS-.MA^E? ANN'/Al FA'ROL- .........................
in. a,ooi,-Qna,
. - C.-==>!.RATt NAME FIRST G..-NC,
-. =-G.AA'JRS ALDRES:- then LIST EVERT SUBSIDIARY
.t;.:-ic,l. D-"` SC -iilSNESC :n tfxaS AND PROVIDE <TS
RR NC
*r AE ADSRESS AlSO LIST EVERY OPERATING
v . .v.-,N. NAME .:SD IN TEXAS AND "OVIOE TmCiR
'. Ni `.CN'IMJf LiS* ON SEPARATE St-EF* AND AT
EMPLOYER SIGN HERE SIGNED
''is wf Yf-*,3N LlGSINu Sv'Tl^iC
Johns Manviile Coro.
P n. Rov vina_____
_ Denver,
80212-
......... .................... !
DATE _ . . / ; /
signature here CONSTITUTES NOTICE on St HALF of employer
THAT EMPLOYER HAS BECOME SUSSORwtk
TEXAS WORKMEN S COMPENSATION ACT
SiPLOYEft*
*t+m, **e -.ompi+H
* m c--*4 ft wdinwmkl
440*m. c=r' iv *" cxy t. wik.4*
John3 Manviile Corporation .
vcr*'
'
a*d*-5**d * ;ut
flBiyTT-
N OF RISK: 2? ENTIRE STATE OF TEXAS
nswou
n DIVIDED RISK -- EXPLAIN OPERATION COVERED 8'
errtcnvc oatc 12 oi am
1977. EXPIRES at i: ;: A M ON
~ ' 'Nsja^cy^ab.
Ideal Mutual ;-rrTn~$ A k_
-<ov r dec.
nn M. J. Nonet :s hereby |M by the named employer and the named imwance company, at requited by the Tout Workmen's Compensation Insurance Ad. Ci-aptei <03. General Laws. 1917. and amendments thereto, that the above named employer has become a subscriber under sard Act and amend ments thereto and provided for the payment of compensation to empaiyees odder the terms and provisions thereol Any emoloyer or association wilfully failinj or rtusut| to tile tins notice snail be liable ior and shall pay to the Sta'e ot Tetas a penalty of not more than One Thousand Collars !J1,000) for each offense.
,r
Vi
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tiu>csxiVAZX"r ~?7--cq sot *jt, to
t ffi Yft '
irx'dtt* yi
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'mm
!';:*.i . .
;
_22=*21r25.____ . .
.< , ........... i,,,
>'" !v "TDBOUB-10UTJ1J -5-7;>
i~,;ri ...Johna-Kanville Corporation at al
I'l'e.i :..... $_18_75/V0
w:; ! I .f.i }''v:r.. 5
The Charter Cab Firs Insurance Conpany
he t.! J'lulior.
Jej lor
*\<cpt t'-w i**.jc\ *n ts:x*r > rrjMrvi to fv
?hc {> i'.rx
fn t-
<* *. - *`hf if..-
* .
`vita*#.! :h** ptf<*rj;*.c tj.nc
'jr j* lj i.,u -.vli**
< !> .j'.arH:
of Shroloyar;
Tcjcaa Locations:
> Iv*'.'-; fr .itt.K'hir.rn? *>
^C*.'
Products Corporation
Boute 75 Denison Grayson Co TX 75020
, , Joanu-l'Ianville Sales Ccrporaticn
285 V 11 St Houston TX 77008 1161 Snpire Central Dr PO Bor 10063
Dallas TX 7521*7
-^L p Southern. Johnn-Manvilio Products Corporation 2222 V 5?th St Port Worth TX 76107
, -i1 u Johns-Manvills Piter Glass Inc
Bouts 17U Cleburne Johnson Co TX 76031
RECEIVED
INDUSTRIAL ACCIDENT BOARD ' ^ 0 76
INSURANCE DEPT.
Wl--n/fll 12'iiTi
S3
v;*-.. .ttF:'.:*T c-
"for *mcH ro txntcr
/= .-
15 it; l
D J--
! WCO 1
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fit ML -*D t | V f . w'4A,
AO' l i
If 'S.'i'
1
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1-
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*f T *
.1
H.'U | r
F!/f<cti*e 'mm .--Q7-Q1-7S-- `Sf vuk. pjy. I tJr
-jt the time of day the
t^unu-. rf,,, i^r d"^M0t.tOttg31t5-TS
'-nec t * _____
jUI.
>* >'' 6-lS-75/
Additional i`*vmu.ir $
Sw Ctertor Cole Tint
\ .li<- .. *r
*>; %. itj : ilxi'.e. cx.-rpt ihc jjoiic* 11 n`*<r. i*
* .v ...
KVf'.irn P'
$
h tM
;.................
lUj'.'ii'.-M
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6><
rfi- *. r
hen' ? *he
\ .*
m rftr
Oit|ontUfli
n u,^ p-i/ia i. '
XSM tanllTW. Saaim T$ Donioon Gxojooo Co S 75020
I rJobo-4fmBcwil3M Soloo Ooxyorotloa
285 11 St Iwutoat TX 770*6 1161 1^1 to Control fir 10 Soot 10063 Snllao TX 75247
/jp3ortte Juteo MmitHIi Tsodarto CoxyonUo* 2222 V 57th St text Worth XX 76107
HtUIo Titer SUM Xm
Bewto 174 dotexoo Toteoaa Co TX 76031
received
i< -pz nvj '7i .J~ 7. \i f.i .
RECEIVED INDUSTRIAL ACCIDENT SOARO
v;z 3 o "'6 :m''i i^ANcr: dept.
< im^, ;^*^gyg**BMP TWjumj l HIIW
anis)
6
i.t * \ 4M?MC ' I" .
ti *a t' !<*;
*****
2 ws.Do Not Destroy
wo. one Extra Prop For 5 COfSARD
TIL
TO.
In-t-e---r--s--t--a---t-e------'O----c--t--,-;- ~:~uW6.V-.] '.TJMUjr.r.TJ' -T"
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Ml
HR.*
" -- TDKO-UB-lv' 4T21 i --
JZ-ULLu
Cl. 'fS-DR-COFVK
?, Marsh-McLennan N'YC-
t'M S' Same-74
H AM 57260
C-6
V EX I
1. INDIVIDUAL "ARTNERSHII* CORPORATION fij
othru
yNomeoi.iuurd I johns-Manville Corporation et ai per 'Schedules 9240 P 0 Box 5108 Addraa Denver CO 80217
(No., Kre*4. town, county. cut*, tip rode)
Laeihem-Atl inuel weekpieets el th mated at et Iron wOkIi oportiiem ovtratf Ojr tka poriqr mo nndudatf art localtd at lb* atott tddtttt won otherwnp lUM homo.
See Schedules 9240
,A
Policy Ptnod.
From:
1101 * M , MM tMMM IM 111 . O. lM.ilI M MM hMM
07-01-75 "
T- 07-01-76
TX. 'Covoiato A ot Ihn policy applitt to It* wortnwiM compontatioR
lew end any occupational wooajoi laaw oi tacft of the taUowwt|
. ^`
slues1
wnk*n c* Mioniwh np| pert o# fh pmMcy See End 9380
o* Hi flct)T
A II indicated herein, interim idjtutmentt premium $hai( be made Cloinfkatton ef Operotrtxn
Sem-Anmi.illv
Quarterly (~j Monthly G
Premium Basis
Rates
*4 tUlHllWi I
Clerical Office Employee* N O C Salesmen. Collector or Me^ngen--outude Dnverv CHauffeun And their Helpers, N.Q.C.--commercial
See Schedules 9240
162297
> to* kihm4 tart* CoHorofo I tidwn of low ood Kapowo ChhNH
Tout S a.0229/
ci Modification
Leu Conmnt $ 10
0020
Irpenee Ornateat S 1C
Modified Premium $ Loes and Expeuaa Constant $
Batiouted Annual Standard Premium $ 162297
Groea Depoait Premium $
006) Premium Diacouat $
$
Minimum Premium $ 210
Dapoeit Premium $
5, Lamit of 1 ubtlity for Coverage B--Employers' Liability: $100 000 Hubjrrt to all the term* of tin* policy havinf reference thereto. 9
Total Estimated Annual Premium $ Premium
to be coll under TPB ,701454
rutCM iM.t 9-2-75 TLT/EG
k
ItNS. INTI
IISS---TTHHEE
TRAVELERS TRAVELERS
INSURANCE CO. INDEMNITY CO
CfiUftV-rc:'.nd hv SLEEP; ^
>lh IS--THE CHARTER OAK FIRE INSURANCE CO
DALLAS
Hi IS -I III-: TRAVELERS INDEMNITY CO. OK ILLINOIS
. I HI IS -- THE TRAVELERS INDEMNITY CO. OK RHODE ISLAND
w\ CO
C-IIHJI ed Octahcf 1**4 *< ta . (f m Mli C*UMI| l*t$
I
D<tarfios StM4ul
TORG-UB-iu473Ll-5-75
for ottothmf* ti Poi* 1 No------ ----
Cm4 Urn.
Ti i
1*** MOCv ol
Urni
3P-- - *. (V'Wi'M
Locations
Operation;
State of TX Tohns-Manville Fiber Glass Inc
Route 174 Cleburne Johnson Co 76031
3-8819.-42
106100;
j
7-1699-42, /l 973900:
\/
0.
68509
comt
..4
1 cmmwm om mm 9mMMta compom
B40
VtUQfUtUHt
_ _ ^ . 4 _ ,.. -_i^.
.TD30-U 13--LC 4? 31 i
ho* tto<Kmnt to ^ohct No-
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Im
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wfw*
t
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-fr -wr tl* --< *
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5 ' J 'V*'-* *' '. i --
4Sfr-'d^HH-v-
~i- *-j*
-"IFf^' ^Llov ~~^
W-- * ,,SJ* -iH-< *****#
*nwf
Scn*4a** _r -_- Umi4
9
Houston 77008
1161 Empire Central Dr P 0 Box 10063 Dallas 75247
3-8810-42
*8-5184-42
^ ^*9-8742-42
T0-8018-42
u3-8810-42 IT' 8-5184-42
9-8742-42 10-8018-42
y
600 i ji
237900 i l 1700 i
0
IOO
5.69 i 0.59 ,
14700 i1 3.27 j
1 13537
10 481
6 0c\i
522800 , 84000 j 5.69 .
658000 ' 0.59* 14600 1 3.27; i
1
1046 4780 3882
477
24214
f
BQ1
JL /
2 j ^OTiCJ^THAT EMFLOYcR HAS BECOME SUgrCRlBt?
<v) D TDAS WOKMen COMftNSATTON ACT . *
A AN0T,CE that 6mployer"has 2?C0ME SU^cfe.
Texas woskm0 coMPEMAtvoN act
EMftFXYS?:
: <
fed evmVH rt*!1"*! *ddrf&,
JW/
4r 'kmmo itdqruptt;
& vt p;< ,** * cf .** * ai %or>tvO*i n r*ett *
Joh?.sJWaviu.e Corporation :t
\CDRESS: PO 3c x 'MOB DenvER CO 80117
.r,A':H^c -jCjc E`;o. tgl.ibiit;
n
,
/.. r 'j
f (/r-h
Q/
^^_____
OCAT;ON O1 R:SK U? tNT.RE :TA" of T0TAS
n DIVIDED RISK -- EXPLAIN OPERATION covered by this policy
POLICY iViagu
htg=CT 1VE DAT E *0 0' AM
. U Vs-iU-
1G4T31 -5-'75__ 1
17-01-75
CANCfctiD
IHSJftAN-b CC.
.. THE TR.vELfBS `ise-BancE CTmpiNr
X THE rHAOTrif Oak '< nS'jPajkE CO.
NEW POLICY
25 RENEWAL
T EXPIRES at 12:01 A.M ON ..
APPROXIMATE NUMBER OF EMPLOYEES: A. S'abl* Annual Employment^ 7 ^_____
3. Seasonal Emplayno.it by MontF- S/A
" jV*`f (
e5.' ~UA< "T "APT '* 1 M.; "r"" JUV*
T" 1
i' r _
r1 |1
" "'oc>. " -nov*"-*' otc 'ir ii
OCCUPATION
Rock rrcOL Mfg 1699
Lot on anon**
"
aooress
gy .i-mc-,-'.': .ennan _NYC-S/v'.L _1221 ATtsnut^ ofjtha
city
iswrica, New
York,
' state
New York
iir
100?0______
Notice is hereby gnren by the na<r.ed employer end the named insurance ccmpany, us leouitec by the Teias Wo'kmen's Compensation Insurance Act. CNcter IG3. General Lam. 1*17 and amendments thereto, that the above named employer has become a subscriber under said Act and amend ments thereto and o-'onded lor the payment ot compensation to employees under ire teims and prtws.ons theteof Any employer or association ilto'ly failing or refusing to file this notice shall be liable for and shall pay to tne State of 'eras i penalty of not more than One Thousand dollars
IS 1.300) tur each offense.
/ I employe* SIGN.*H6y
SIGNED
Insurance Administrator
TITLE OP PCRON ION1NO NOTICE
DATE. 9th December# 1975
*eesR
| INSURANCE COMPANY Sign here
___
THE TRAvewEHj .HSoC aCE COufANr
X 1 :naPt=>
e;fc ;.<H34N^ IfvA.V
NAMt OF INSURANCE COMPANY OR ASSOCIATION
,, ?D iOH.'i St .
i j .tJt-Yaas. !r_!.03S
AOORtSS
SIGNATURE H*E CONSTITUTES NOTICE
SOOO(Txs)
mi f76NUT E. RETURN Tim .NOTICE TO YOUR A SUE COMPANY * Ot) SOT MAIL TO INDUSTRIAL Aid :E dJpT*
_ ... QTST BOARtL ______ _ ^gUKANf-
^ TtTLt Or PCASO H/f%SI\CvaNNINt! NOTICE
SIGNATURE HERE CONSTITUTES NOTICE
ON BEHALF Of INSURANCE ZCOMPAZNY ..\U
'7
At t - s!t*.
ORIGINAL COPY
PRODUCED
'l. . 11-..
Jn) 7 m*lt
yOJjCEjHAT EMPLOYER HAS BECOME SUBSCRIBER
recAS wcDMSo eoMENSAncM act <'
r'i.OYR* *
* a*T tfdW'Y *'*d****flH *,
4 eo*rt#c b* ?Kh w*cy ard*' **"
Jc:r..t~Manvllle Products Corporation et ai (See Taj "C^Ca____
Texts Location* (See 2nd 8000
ADDRESS: P.0. Box 5108 Denver CO 80217 IOC '"0*1 Ob =>SSK: <3 ENTIRE STATE CP TEXAS
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NOTICE THAT EMROrER HAS BECOME SU8SCRI3ER
TSXAS WOM* COMR5NSAT1CN ACT
CR!
______________________________ ;
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J3HNS-MANVilLE uORPGRATI OK
al See t'' * f jiE
-_;--:--= =--
^osestf
innoccc
**ox 51CS Denver CO S0217
lOCATlON OF R'SK: 3 ENTIRE STATE OF TEXAS
v' f' DiViCED R.Ss --;XFL/ N C-FZRA'iCN CC.eRED Sv >13 PCL-CY
/J"' c
: JilUuvi-
1047311-5-73
NEW POLICY
Ju'- 1 1373 s RENFWAL
~ A *i , s ,, i i;
Ni,.MV.t ;o.
^=; the travelers insurance .:ouf*S'
X THE CHARTER 0a I--IRE iJ._ranC CO.
s EXPIRES AT I? 0! A M ON
out 1 1'
APPROXIMATE NUMBER OF EMPLOYEES: A. Stable Annual Emoteynerf:_ .
3. Seasonal Employment l;y Monfh
L '87
JAN
: Hi" " I MAI
; AT*. j MAT
I
OCCUPATION -sses~:s Cocss
ACT OH aPOP CP
VARSh-'/CLEMiAN
Vr-
I.Yt
i?s;
_
Acsnu
oitt
state
1221 krmtaxm _o_f_ the _M__tric* New Ttxrk. NT 10020___________
fats* it hereby liven by the nvned emplcytr and the named intwanee company. at required by the Teaas Workmen's Compensation Insurance Act
Chapter 103. General Lam. ]91 /. and amendments therein, that the abow named tmployer has become a subscriber under said Act and amend ments thereto and presided to' the payment ol compensation to employees under the terms and precisions thereet Any employer or association rilt-jity faiimf or refusm( to I'le tins notice shall be liable h> and stall pay to the State of Tesas a penalty of net more than One Thousand Dollars IS! 000! tor each ottanse.
C'GKD
j DUE:.
4 it
Insurance Administrator
TI-LE OH PCHSCN SIGNING NOTICE
3.19.74
1 *v. r. C'V't'N' Z*`. l*i*
___
' f 79inSbQ V-.*AN/m? ;CmPah* \ The CHARTED Cap' F RE su RANCe CCwPASY
NAMC Of mSUNANCe CCME-ANT OR ASSOCIATION
3C uOHt. St
:.* York
-n
A
SIGNED- U^_Lu-CUpCsUiJ&li^Lr ______
j SIGNATURE HERE CONSTITUTES NOTICE ON BEHAIS OF E
K-. 11 |
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i
it k-. ini' \urtu io rot r i\.ui t > si />: \ >
;</ '.fil st.t// ro tMMWRHI. tec I-
iii \ i no tK/>
-AeC
o*y
SIGNING NOTICE
^ ^ 02 74 SKNARIK HERE CONSTITUTES NOTICE
ON BEHAlf 0E INSURANCE COMPANY
Af t.d --. C I Mfcu hdtW'2-6* W'RttO O.J.*.
*<50*
INI
ORIGi
+4 S\N\'E I'tiMfWT
m M * t S.A r f j twmm nr1*
CounterftiKiu*ii !>>*---.
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_____ At ;v ;!** -f :r, tt** t* ii?i Ik-`'tr.**
,,ut. . Johlnec-X-KaannT-irill* Corpora'.ion ct *1
h- !.i-: "2b--'7^
' j.
tjsc<;b- io^n i ** * ;'*7j
rh I : nia*,M ^a..!*-1 hi jUm-, vuvj.-J
j* *'.. V"* (h? p .:,
*' ', ' * '- t :
ii ks jsri-ed that m of the Jfcc;i\e date hereof the pclic> i-- am.-ded ir *>*. i :v'
dO'
Johns-Hanrille Salas Corporation
Southern Johns-Xanville Products Corporation
Johns-Xaxnrilie Products Corporation
Johns-Maurilie Fiber Glass Inc
Texas location
285 V 11 St Houston TX 77008 1l6l Hapire Central Dr PO Box IOO63 Dallas TX 77247
2222 W 57th St Fort Worth TX 76107
Route 75 Denison Grayson Co TX 75020
Route 174 Cleburna Johnson Co TX 76031
*****
^ T*AvF",wi^<^75rAv''
Tile CiMJtn.* Ouc Fjk<t In-itra.ncv Comf.ixv
.S*crfiry
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DIVIDED RISK ENDORSEMENT - TEXAS
;.- vw-
.- ...... ' sch hwmw-w is affaidail by toa policy by
< *b* daoitaarioa af Toaaa ia Im Sal to* dsdaaarieaarV^
doe* ikk apply to iajaty, iocioding death teealtiaj theuboei, metaieed m to* apmcaa* pacified b*i*wr a*to.,;'? atm boeia fee aacb laaanaca, ah*U aM Iflal* the mwmIm tttmm
2. Nothin* ia toi# eedocaeawm shall reliere the co*pany ar the iaaand o< oblijaboM uapaaad ape* ikes by
Tana Mam'* Ganp**etfea Late
. .. &
OPERATIONS BXCLtJDSDl
.y.'
l. Operation ia a baalaaaa
fraa to* baaiaeaa ia which toe Teaaa operarieat laocribad ia i
daarribad la toe dadatadaaa bat canted by to* policy at <
All operations except operations parfocaad for Onion Carbide Corporation Including operationa any fron tba project alee 4.f directly related to the operatltma for Onion Carbide CMperation.
^v/awlvebatow*.
P
NC'iCE THAT EMPLOYES HA'j hzCC-Ar. S^slC;.-
0 i "i i
IEUS *'OMtMeN,S COVefWSanort ACT
EMPLOYER:
<; .>
a i *.e
Mury
)
<? ****** (tv 4 t*3*r* '? wk " re
_____ J.<-'hPAclansa.LIe .f.rq^iLts . CL r^r&tlan;. Johcarldaru
. rid..
_____ Corporation; Johr.g-Mattville Fleer Glass. Inc.; Southern_______________
Johna-Kanville Products Corporation.
ADDRESS:
____ P. 0. Box 5108 Greenwood Plaza Denvqr^Colorado SO--17_____ v_
LOCATION OF R'SKt JJJ ENTIRE STATE OF TEXAS
DIVIDED RISK--EXPLAIN OPERATION COVERED BY ~i i tC:. C"
TDROUB_926R0-+ -_7_2__ _
' NEW RClO
______7-1-72 yQg RENEWAL
IQC
~~ EXP-RE;- a< io: AM
* ,--N`Lc JJ.V-AN ; -riL^ANCt .
7-1-73
a=pro>.:matE N-JMBER of EmRlOvS.
A. SFeb*n .A,-*s E--picv-i*-*' JaP^"*____*
B. Snascofl: Eti*D:Cvr*'nt Cry Month: N/A >s" ~ Pi) I UAf "T" a** ' UA ' I
.Manufacture and Sale, of Building. Products
occCaat oh
Marsh f McLennan, Inc. 1221. Avenue of the Americas
4T C lioicA
*~OnCS
C;-~
New York, New York.JQ.Q2Q
STATK
i'.P
Sp;*t .) htr*tiy |'voa by rfte named rvslover v*3 :v named rfmirarci eonpany; as : ftJitCO by tv 'fiat AorImens Compensation insurance Art.
Chapter ii3. Gfriv',.
5; t m; a-nenoments tH*r?t; tut tv .:o *. uevd ynpoyc fat tcco-v a suesc-ber under said Act and antend-
me-'s if'fte and provided ter the payment c* caoiMiiut.cn '3 et-f cJes ender the 'erms jnd prcvis-ons thereof Any fte-KjYer or association
oi'.t.' Si tf'ir.| or r`usmj t.se tins notice she at < at't tv end stall pay to the State of tens a penalty o< not roc-e than Coe Thousand Dollars
-SI.000! tor each otleme
*
\
| . ,.3A
-Va-R*MC5 j fcp/,4^-5 >Aprp Car f Rf 'NsjRakCc COwPANY
I NAME or INSURANCE COMPANY OR ASSOCIATION
n
a
F. U. TngH^t. Insurance Manager
------ --
jiCNvJ^Jjpp'CfcZ
-
{. .80 3ohn_i5_resT__ NjgwJtpck*.Nj Y_10Q|6
I AOCAt*
iSlSIKD: fcftvc*..
-jw .(Ln
SlGMTURE HERE CWUTITUTIS iXlCC ON BEHALF
Te^'T
Swii K/.rft K#c\\ //wH*\ S\'fff/! -i a
' at k
ith u;M/*jsj t
______
_ S*^*r*^M <7JI ... . - ^ rv!
TITLE Qf PtHSOH 9IGNJNS NOTICE
tMi \>)l
ro /V/4AI
nf \t muttx
/ -Mfh
IAS Apc*o*m ** 3-.*r
20H Iw'**1 Pr^, Co. f C >o tWI
Vm 7*717
C*:i6M Ht* ' 2-OT **TEO ,M J.J.A.
of^:G!NAt -:c :'v
sjGwmt mi :oxsTiTUTn wmc ON 8CHAIF Of INSURANCE COMPANT
I .b
produce
I'rtiu t ' * *7 * net 'WaVJ.1** l/dSUtfANF'l QOARNNt
- 83
mmmm ' 4. .
nygMa=22.68ov H-' 7-t-7t
Q NEW POLICY
jp *BWAL ,
__________ Htbu^Awci __________
i
THE TKAVtlltS INSURANCE COMPANY THE CHARTER OAK EIRE INSURANCE CO.
[2 OP1RES AT 12:01 A.M. ON____=J2.
APPROXIMATE NUMlSt OF B^PLOYEB:
A A-------1 ----- >--------1-
|I #-M----w---N--1i >B----^-Iw---^--I--M---I-!*i I_B_j*MA-B--R- iTLn.*
w ~W1 " UAL-- --X7E-- .u*y
m "1UL ~ aM. --nr~ --BBT- --BBT-
MANUFACTURE.AND.....?ALE-.0 WILDING PROQMCTS
Mies b Imnby abas by On sshsE iMsby* S tbs mM iMm emom. * m** by tbs Tot bbrtwWi
OHyNr 103, Otmrtt Uwt, 1117, mt aMi thsnts, tbst tbs kxn und mytoytr bM bsmss a Nbscribw ssSsr nM mI* IabMmaAftt ot pmwi jmILuav wmik ^or combpmkot ^v M- -p -iy--v- _N-- i-mJ - -r im nn mb mrimi** * A^Wi^rjitaiii| IH* tW* ntto Ml b* Mb far 0 stall w tt tt* SMt o( 7cm pMMlty
INSURANCE COMPANY 9CN I THE TRAVELERS INSURAI 1 THE CHARTER OAK EIRE
I company
NAME or insuhancs comaany oh association
CEggftHN ST NY NY 10038 C-6
;ri&
*A1 ,/i-V
pJ$0lJJP(0
Saw
U. MMS Of.IMrtOYOU StfSrtays
K*. .\*m
--** tv>
-i vi;. . , '. T.
*2RV
HAS KCOMCSUtSCME*
user' f
7TO1
t+ * i *9*
WOlfta*
m CiUiUlHf TX
klL
joh3.j^rll *ic5C0RF0**t row ^6ay west mw st Houston tx, 77oot t'*q*n><*,Wryr <th L utaontn Ayr rnr wqIth
w 7JW*. RT WORTH
adoSS.-2? FIST M ST NT NT 10016-----------------------------------------------I*-Z!7--
[: LOCATION Of RISK: Q BdTlRE STATE OF TEXAS
AS SHW ABOVE
WVIOS) RISK--EXPLAIN OPERATION COVERED 8Y THIS POLICY
policy Nuaiaea
1 arrecTtve oat* U:Ot am
TDR0UB-926804-^0
7/1/70
CANCELLED
INSURANCE CO. G THE TRAVELERS INSURANCE COMPANY jj the charter oak fire insurance co.
NEW POLICY
B RENEWAL
EXPIRES AT I2.-0I AM. ON___ 7/1/71
>1
APPROXIMATE NUMBER OF EMPLOYEES:
A StabU Annual Pwiplnytnui-
8. Saaional Employiwawt1 by Month:
JAN. --mr~ MAS.
Aft
MAT
--rcsr
4UU
AUOj
~Bgr
1/1/70 PLOYEES _ .
.............. Z_
MANUFACTURE ANO SALE OF BUILOING PROOUCTS
oecuntnoN
H1PSH ft HC LFMMAM INC 70 PINE ST NY NY 1QOO$
act. on bnoKnt
oooataa
city
IteUa* la kanky fkna by tk* wri amtoyar Md tha wand iaaanaea coM*aay, a nonrad ky tka Tam toactern't ( Cbaotar 10S, Osaaral Law. 1117, aad aamdMate tkarat*, tkat tka akaaa aaaaad aaylaiir kaa bacoaa a rakacrikar Mdar aaM M 1 am tkarste aad ptoddad far tka payanat of caaoanaatlaa la kaytoyaia uadar tka tanas and proaiaian tkaraof. toy unalnyar or 1 agfpH^ftttnt or rafuw* to fila the aooca skaU ba liakta tor sad steR pay to tka State of Tam a passtty oi aot laara tkaa Oaa IkaaM
Star 180. ' tar *
EMPLOYS* $IN HERS
HBIHHH
nan,
fTr. Ingtma
^
InJuVonco Manager
nru op askarm monino None* *4J. 1970
insurance company sign here
IlHi
G the travelers insurance company
THE CHARTER OAK FIRE PiSURANCECOtoPANY
NAMC OR mSURAUCt COtatatT Ota AOROtaUKTfOM
80 jam ST BY MY 10038 OIST t
AOORtSta
.... .../LiAjj* dtMjLRjtjucCAiU, TEL
sumtuk hoc coMmtms nonet on nwr of unora
NOTI
Hin t JtN THIS SOTIlX TO TOOK 1NSUR. ANCt COMPANY
DO NOT MAII. TO INDUSTTRLU. ACU O/LVT BOARD.
IAJ. A*rf*H l.
finiltf
CatMIA NCR fla4* MllTU ill UUaA.
.Co. 9,0. to tata Amiw. Tin 1
ORIGINAL copy
ACCOUNT ANALYST
TITUt OR RtROOM MWItata WOTICt SMHKMK w88f QMffVIMD HBVKK
J>nr
- S3
K'^
E\ ,
TEXAS WOWMKYS CQMTSNSATtOff ACT
&- iwiitfliF Mruyit SiU^ZSS
i tm --i * r*A
JCWa-KWVlUX CORPORATION
*v> % '' .*$f ,
5.41
JOIMS-MANViLU: SALES CORPORATION 28*5 WEST tITH ST HOUSTON TX JTQOfr
SOUTHERN JOHNS-MANVIUJE PRCOUCTS CORPORATION
VEST 5TH 4 HARROLD AVC TORT WORTH TX 76TO7
JM
f") NEW POLICY
,_
5* TDaoue-926604-69
LOCATION Of RISK
Q ENTIRE STATE Of TEXAS
..
nL M oocfotion *, bvrt,,.poLcv
AS SHOWN ABOVE
EFFECT]VC AT 12:01 AM. ON
. EXpfftB AT 12:01 AJA. ON -Zfl/gL
ZfiSLAPPROXIMATE NUMIEX OP EMPLOYEES
A. SleW* annual smptoyman*........ S. ITfonal amploymant by mantti .
FtWwr
MANUFACTURE AND SALE OF BUILOINQ PRtXXJCtsjjg:
occupation
MARSH 4 MC LENNAN INC
AGENT OR SROKEX
70 PINE ST NEW YORK NY 10003
NO. 4 STRCCT
CITY
Not< * Perwby Qwm by ttw ainohnar end Pha wmad Inaumnca company, a* raqwtd by tha Taxas Workman** Comparaettan hmenca Act. Chapter 1031 Waul Lows. 1917, and omendmants thartro, that ** abort nomad ametovar poi btcoma o tubsenbar undtr >od Act and omandmants rhatato ond eroridad ror iN papM of compensation 10 *<npioycs wrttsr lha larm* and ororeon* tharao*. Any amWovar or ossociolton willfully tojlmo or rahwnp to hto the nahea thee be aoBtt *V and snail poy to tha Stott of Taxes a ponotty of not mors than Orta Thousand Oodors (11,000) tor aoch ottanaa.
EMPLOYER SIGGN* 1ERE
MJcSIGNED:. F. W.
ia
ugnc Manager
OATE:
TITUOfttMON MMIN NOTICS
______July U, 1969
SiQnatu't hm ecmlltutn nortc* on bdulf of niploftr
\ 1111 liii.--. tl.t. '.utt to \niir fiHiii.tcK.** Oimiuny. IK. 1.. t it.ttl 1m lmliisiti.il Aitulrul IJiwfil
FORM 1A* 20-4* tEama,* 20.S4) CDIOi I2 M mRTCD m U.*.*.
INSllRANrP COMPANY SIGN HERE iSISnBftnNINMMfiUQMPA
I COMPANY
NAME or 1NMURAMCK
k AMOCIAVIOM
S.J UBow
\Ajt&<
mtOPPIMOR SignQtur* harp constitutes nonce m I
80 JOHN ST HEM YORK NT tOQ^f . gg
A
/flw-vti&Sf. V- V'. .-^3
. i`*4
*.*f\j4 ,y-,^Sv.'-..
.^kSsY**. - :*' - !-
", 'vjiW .*,.; 4 <ey?lg*. `Vji&r '
^f;*r -*/' ' ,.v . r;-^'.
^-: -:'. .JOHNS-HANVIUX' CORPORATION
'1
ROUTE 75, DCNISOV TEXAS 75C20 :7T\
44lO HOLMES ROAD HOUSTON TEXAS W&i, ROUTE 174, CLEBURNE TEXAS J&Qt
JOMdS-MANVILLE SALES CORPORATION - 2825 WEST ttTH ST HOUSTON TEXAS 77006]
SOUTHERN JOHNS-MANVILLE PRODUCTS CORPORATION
WEST 5TH A HARROLD AVE FORT WORTH
TEXAS 7*1^7
--------
RECEIVES
ftUG *81368
nEW POLICY .0 .
S3 RENEWAL OF P9LICY
m, TDR0LB-926804-b8 * TDROUB-Q2b8<-67
iM-ntm or on*:
Q ENTIRE STATE OR TEXAS
0 If divided risk, give operation covered by (bis policy
CTtrgnvriT maniH..v ~~~ 7-1-4 ACCIOE
SHOWN ABOVE
OCCUPATION
NUMBER OP EMPLOYEES
MANUFACTURE AND SALE OF BUIL0IN6 PROOUCT 3
940
user O* teorza
Nr. O Mrrrt
cm .
MARSH A MC LENNAN INC
70 PINE ST NY NY 10005
ESTIMATE* ANIMAL PAT--LL
$7 ,000,000m
Notice is hereby given by the named oaiployor ond tbo nosd insurance company, as required by tbo Toms Workteen's Cnmpaw sotion Insurance Act, Chapter 103, General Laws, 1917, and amendments thereto, that the above named employer has bacaeaa subscriber under said Act and amendments thereto and provided for the payment of compensation to employees under tha terms
and provisions thereof.
EMPLOYER SUM HERE
HHHHHI
F. W. IArfiam
LiTriNiiran^M Minogor
TITLE Of PESSOI SIMM-- NOTICE
hRTPt Julv 31. 1968
SIGNATURE HERE CONSTITUTES NOTICE ON REHALP OF EMPLOYER
NOTE: Return thit Notice to your Inturanee Company. Do not mail to Industrial Accident Board.
PORM 1A 20-VS iroRUtRLT ISO)
INSURANCE COMPANY SIGN HERE
THE TRAVELERS INSURANCE COMPANY
^PH--T-H-E--C--H-A-RETEiBRiVOAcKnmPIuREx*IN! eSUeRuArNmCEmCuOjMwPAuNtYhe .................
ONE TOPER SQUARE, HARTFORD, CONN. Nil]
AMOS
ASST TMitGicRor mw mdrwblW
SIGNATURE MERE COMTITUTHX^nlqi^y
10098
THE STATE OF TEXAS
INDUSTRIAL ACCIDENT BOARD
AUSTIN
I.A.S. enrr. Na 7
I, William Treacy, Secretary of the Industrial Accident Board of the State of Texas, DO HEREBY CERTIFY that the attached and foregoing constitute a full and correct copy of the Board's entire file of record in this Department in the aeaflBflBoeefleaaBamgia
SUBSCRIBER'S FILE # 065693
I further certify that certain of said instruments bear the "receiving stamp" of the Industrial Accident Board and that each of said instruments bearing said stamp was received and filed in this office on the date shown by said endorsement thereon.
I further certify that I am the lawful possessor and custodian of the records of the Industrial Accident Board of the State of Texas.
IN TESTIMONY WHEREOF, I have hereunto signed my name officially and caused to be impressed hereon the Seal of the Industrial Accident Board at 200 East Riverside Drive, First Floor in the City of Austin, Texas on this 13th day of July A. D., 1982.-
R-7 (3-80)