Document GmNRRo1Y4ke3b2qqJYxD0e2qn

FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1963 DOC#: WCC011 DOCUMENT DESCRIPTION: Workers Comp File - Novak, Edward Contains all documents found in the Claimant's file, with one blank page between each separate document fs A 1 J /e r \ .2 6 1 -0 2 1 6 Cable A d d r e s s Alexcand' T eletype 41 2 - 6 4 2 - 2 i 0 2 ' ;: ' A L E X A N D E R A G E N C Y ; N C , : - v in s u r a n c e -w o rld w ide s in c e ii ie 3 ; J T ' ' - .Y- A - . 3 1 6 F O 'U RTl R a v e n u e / - P I T T S B U R G H , P A - , 1 . 5 2 2 2 ' ' October'20, 1964 (Tuesday) ** R e lia n c e ' Insurance . C o m p a n y , . / - d-'%--'''"'l<r f- v . ) L . - . f / v ' . / ; 54$ s . . ;Kings le y Driv j.-- 'fr <A;*'V; v }-' y - / . '- / ' tv - Los Angeles,- C a lifo r n ia 90005 *r~:-J V / "--/" -'V *- A t t e n t i o n s M r ' McDonald^ , ' r, yl/' ' ReV C laim NoV;'91-C /436249 v - \ - :y: ..-*. 'Armstrong Cork Company " "" / Gantler.ens '>{ v` <1-4 ^ J * " -Thank you for your "letter of th-19th. concerning'the above,': Your . letter.of .the 9th-wouldj ' " ' ' ' ^ 1 " '" ' The. Armstrong Contractlng"and Supply Company was-brought into; OV* 'existence'.on January" 1-, 1958, it' ivs"formed"out .of .thebContractin Division of the Insured, the A'fnstfpng Cork Company.',. According fc information received from. th Armstrong's Home Office. Mr. Novak'/'/- '/ 'was employed from'1940 to ,1952. h .Vv <--- ' -* fard Accident .Insurance Company" had -no coverage for- the .Armstrong; Contracting and Supply Company..: y / ."a //-'-J' '- 'Tr-anking ,you'for .your efforts'in., this matter, I an,. V _ -- .-.Very .truly yurs, ..G - - '- /. ' J l,-" %?{ BRS:eh iw -J". . Beverly R.-Scriver--l ~b"Y .' OUR SECOND CENTURY OF INSURANCE SERVICE /k3v;v ^.v i^ c-.<p|nta-. r. litgjtoo ..tu c..v . v - , rt* ot '-'J -." tu o**; :.V ;Y_. J \'t- ;:V V ,rl*-* ' *fti iakmi Y i-; THE* $*rf<rr %nltt ,!* * * ^ Y - ^ -i' -- ' *"V " ' ';'1. ; ' ' *rT% * 'S * SJ"V3f3 ; ! ; : s . ` ~r- ' -' ' . *f" ^<r^8- n T- *-J* - *- *'. ^v***<***"it T* >^ ,,""V-^ % , S**-^ V, .-t AfJ't.ii**J t ^ ^ ' - . * - . -t _ -'. '- ' V ' ' `S ' _~ ' - '"" -- ' ''hj M. M. ___ ^ -Mr-*, fi.% L }- '. -f \;y i v v w H / J & i i i * * * p c ^ i s v ^ > ; - : - .=* v *. > i3 - A j f w . ' _ v - r-. \ - i i -- -- . ^ --* - --* JT'-. 9f otti -, a-r* * */ k- ^ . . *'I V >?****V-** -'*ci^,vt: w*j *-' '- * *- ' *f ^ w*t >{ . % >O *? -- i*.^** * + ''* '* ' * *' C '1 "' *! ' ' X. . U' ' /t * ' * k' r - t -< j iit y ,-.;. / %*. y - ------ : : -.-:y-.. '}V ^ X'i1*-.**. A H '-t :-*,,- 1-- .' .* " ', T .? - *. ' -V,`"*w-tr**'-;^. " ' v ^ ^v '1'. ' f y r * - > -'. .* '*"v'--^\rJ;- y -v\'t-*1v^y-v-,.-S*:/' -J*- *s.^:-'---;.y,\?' v*-_4/ **k-.-V' :;;c ,yr-:~:,*?,'--' , , ^\ y - *;.V.;.i..-/. --- - -' ' t Before the Industrial Accident Commission of the State of California ; j. "\ F s d h a r o fiovAK C a s e N o . . (^ h k 0 *. > ' ' , ' . ': Applicant > . : -5 v. TdQz?,i 'iiisuthnoz-'cQ&ja*t; Z t74 ATTACHED LKTfUli ADD : .-.'.-- -t ,':A Order Joining Party. 'F'* o I- ' - / T ic / D efendant*. -v U THS ATTUA CASUALTY Aim` ^UHSTY C ^ P A B Y , ' - K ;/. ` Yii- COrv?0PATIOHJ PACIFIC HHPL072HS XuSTRASCH'-U ' COM"ABY, CO;mO::AlIOH? PILTHASHS -HJKDU Y OC- ' IPAwHAKOH CONPAITY, ' A:OKPOU\ Tl OH r~ Defendants . . \ "... ' G o o d Cause Appearing Therefor: : V' i IT IS HEREBY ORDERED THAT'-. v O/'Y f ; c ' - ': ; T A ii PAC AiTfHA c a s u a l t IF IC -hKFLOYHnS y 3a t d - k m s ?Y c o k p a s D UHAHvS C.OKPAiiY, yA, -a c o u p m k n io H COKpOR.-vYlOIi, , A -F P- '-E/KA-iHS ITHD: IHSUH... a-HDSv -COM. PAN>Y^ A....C0H?QHA?I0.2'f ` : / - 1- ' . `--U * j r ' ; A ' ' . ' * be joined as a party defendant in die above-entitled cause. ,--' ' .' . - August 29, I96I4. - U. ., Parties served! S/20/h - . . - 0 s-FUidlwlalradstTo`1v. akK,a y 3*355 HIverton. s* 633L H ollyw Avo*, ood B l North v d .,- L Holly,-ood A ---- - - - - .C ' -------------------------- V - r ' Thorp o Insulation. Co., -27?}1 S, Yates, LA : , - RefeTee ..' .H ; - F V - Farina En.cLncaring C o , a k a Fiberglass I!n..In d u s t r i a ^ a c c i d e n t c om m i s s i o n : 5933"!olograph He!.,- LA 90022 ' . : *- 563 99932 P a s c a I n s u l a t i o n .Co, , E V a lle y d lv d ., LA 2 9 0 0 2 2 v P l a n t I n s u l a t i o n C o . , ? l i l S , Y a t e s A v o . , LA. -aka_ Thorpe In s u la t io n C 3 1 Ja c k s o n K o p k in C o ., Pox EK>, B a k e r s f i e l d 5^37 Armstrong C o rk C o ., P a ta ta S t.., South O nte.' 3 8 A m a t r o n g C o n t r a c t in g k S u p p ly C o . , E EC D i s t r i c t A t t i U onald K. u lv d . , LA ? D lp v i l i 3on ;0 9 P l a n t A s b e s to s C o . , i y i \f. t h , Long P e a c h ' . Narine Engineering Co., li+301 An3v/orth, Tardona Pacific Huployar3 Ins.. Co., IjO^O Jilshlre Blvd., LA 9000^ Firenan's Fund Inr. Co., Pox 23?3> LA 900;'^. Att: 1?. ?. Shoop (2cc) 7-:io Aotna Cas. c Surety Co., 2)4Oh. uilnhiro Jlvd., LA 9PP1}. . 'Joingsnd, Ken dig & Stockt/ell, 611 S. Catalina, LA 9903^. >Copy o f .application oorved 5/19/63* - INDUSTRIAL ACCIDENT COMMISSION STATE OF CALIFORNIA E D WARD 70VAK N otice o f H earing Applicant__ vs. THORPE la slT A T a 'COi-CPY, E? AL Tv . SES TTACIIK' B D `V T H E A R P H A C A S U A L T Y A2D 3U:12'?T 'COHRAdY* A :` OF.POTA.POJ P A C I F I C KJPLOYSS U i S T R A R O S - ; . COMPANY, A -S Q R ? O H a ? I 05 PIRK?tA-*S-'FUHD :. v I HTHIAMCS COPAHY, A nppRI?I05'\- - ' D efen dan t^ ] . Cse iVo..-l63A__25_._051f . F: * ' ' - j- : V t r h Y ou are hereby notified th a t an application fo r com pensation (a copy o f w hich is attac h ed hereto ) has been filed w ith the In d u strial A cc id en t Com m ission o f the S tate o f C alifprnia. Y oh are fu rth e r notified th a t said application has. been set for hearing at \ ; -- ' . ' ' - 4107 LOS ANGELES STATE OFFICE BUILDING, 'l 07 SOUTH BROADWAY' . ' ... LOS ANGELES, CALIFORNIA . :' ' - - O c to b e r 2 , 1961j. ,9 :0 0 A.**, a l l Any and th a t at said tim e and place the Industrial A ccident Commission o f the State of C alifornia will proceed to hear and dispose of the said application in the m anner prescribed by law. .. N ote: The parties are expected to submit all issues In controversy for decision at this hearing; therefore, all necessary vmnesses, evidence, documents, medical reports, payrolls, and ocher essential proof must be available and ready for submission at the hearing. ` -*'* ^ "** . Dated: LOS ANGELES, CA LIFO RN IA - ' t/so /b k ' - ... " IND U STRIA L A C C ID E N T COMMISSION U By : ' H I L L I A H K A p L / J i ' ' Assistant Secretary T he undersigned certifies th a t as an employee of the In d u strial A ccid en t Com mission she served the foregoing notice on the parties hereinafter m entioned, at the tim e set opposite their respective names, by depositing a copy of said notice attached to a copy o f the application therein m entioned, in a sealed envelope in the U n ited States m ail on said day, a t Los Angeles C alifornia, w ith the postage thereon fully prepaid, and addressed to the said parties a t th eir last know n places o f business or residence, as follow s, to w it: - _ ~ A N am e and A ddress o f Persons Served . ... ' b. ' ^ D ate ' ' ' . See a t t a c h e d Joinder* Tor service. FOSM 35-L (RCV 2 G2) T 1 __ r_s(s'Sn'aTURE of PtLC c t HOTJCtl September 11, 196b <2. ' ' ` ' T Mr. B. K. Sbriver - .. ,, , ; Alexander Agency,' Inc " 316 Fourth Avenue Pittsburgh# Pennsylvania 15222 ' ; ' . Bear Bevi . ' r '' ' Subject i 2dwar& Novak - 'r :.V. .v- ' 5. , ` ' y `/ ' Versus ''. v\ . - ' - Thorpe Insulation Company, et al ' The enclosed Notice of Bearing and attached application for benefits under . tbs California workmen's compensation act was our first notice of this ' occupational disease claim. . ' > / Since the Standard Accident Insurance Company insured Armstrong for vork- / 'men's compensation liability during Mr. Novak's employment as an asbestos worker from 19^0 to January 1, 1952# we request that the extra copy of the enclosed papers be sent to Standard's Los Angeles Office for handling and protection of our mutual interest. We have not checked Mr, Novak's employ- . cent record with us but we estimate it was about ten years ago when he was last in our employ. _ Please request Standard Accident to acknowledge receipt of the enclosed 'papers. / ` Sincerely yours, - . *'. BJH ' -:V; r, , , Enclosures Wallace B. Hofferth Assistant General Manager Insurance Department - - Subject Edward Novak Former Employee 261-0216 CABLE AODRES5 ALEXCAND TELETYPE PG 891 ALEXAN D ER AGENCY, INC. IN SURA NCE-W ORLD WIDE SINCE 1 8 5 3 3 1 6 FOURTH AVENUE PITTSBURGH, PA. 1 5 2 2 2 September 14, 1964 (Monday) Armstrong Cork Company Lancaster Pennsylvania Attention: Mr. Hofferth Re: Edward Novak Gen tlemen: Thank you for your letter of the 11th enclosing papers in connection with the Hearing of the above. I have forwarded your enclosures to the Standard Accident in Los Angeles. Very truly yours, B R S :e h Beverly R; Shriver OUR SECO ND CEN TU RY O F INSURANCE SER V ICE Mr. G. H, Finlay Alexander & Alexander, Inc* 2225 Bbrth Qjarles Street .. Baltimore, Maryland 21218 September 1 1 , of this California workmen 'a compensation claim. Attached to the notice is Mr. Bovak's application for workmen's ccmrpcnsation benefits, The period of employment involved extends from 1$40 to December, 1958 and therefore involves the Travelers as the workmen's compensation insurer of Armstrong and Armstrong Contracting and Supply Corp. from January 1, 1952. Armstrong Contracting and Supply Corp. is a named defendant even though the period of employment involved is prior to the formation of this company which was" on January 1, 1958* ,'' ; ; - We will put the Standard Accident Insurance Company on notice also since it was Armstrong's insurer during the employment period from 19-5-0 to January 1 , 1952, the date the Travelers vent on the line*. The Hotice of Bearing and, attached application are being sent to you in duplicate so that you can send a copy to the Los Angeles Office of the Travelers for full protection of our interests* Receipt of these papers by the Travelers is respectfully requested* \ Very truly yours, BJH Enclosures Wallace B. Eofferth Assistant General Manager Insurance Department INTER 'OFFICE COMMUNICATION L- /}] /Il /o V Arm s c tr OM Jok . n g To From Subject M, K* Bare, Jr., Employee Relations, Lancaster g , G. Patterson, South Gate Plant Armstrong Employee Edward Novak October 1, 1961; Dear Marti Enclosed is a copy of correspondence which was originally addressed to the sales office here in Los Angeles. As you see, the letter pertains to a workmen's com pensation claim filed by Mr. Edward Novak. Both Armstrong Contracting and Supply and Armstrong Cork Company are listed as former employers on the legal papers. The sales office records indicate that he did not work there. We do not have any record of his working in the plant. Mr. M. C. Sweet, AC&S, indicated that Mr. Novak was employed by AC&S at the time stated in the letter. Mr. Sauer at the sales office forwarded the letter to me. _ Mr. McDonald, Reliance Insurance Companies, has told us that his firm provided workmen's compensation insurance coverage for the sales office at the time in question. Mr. McDonald would like to receive a written statement from someone there in Lancaster stating that Mr.' Novak did (or did not) work for the Armstrong Cork Company. Dates and location of employment should be stated in the letter, if applicable. With a statement from you, the legal department or from some other appropriate person, Mr. McDonald's firm can take whatever action is appropriate. He has asked that the correspondence be sent directly to him. Perhaps copies should also go to M. C. Sweet, C. B. Sauer, and to me. Thank you" for your assistance. Please let me know if further information is needed. Best regards, DS ?/l, Enclosure Mr. V. C. McDonald Manager, Claim Department Reliance Insurance Companies 51;8 South Kingsley Drive Los Angeles, California M. C. Sweet Armstrong Contracting & Supply 1;3U0 District Boulevard Los Angeles 58, California C. B. Sauer Armstrong Cork Company 5983 Smithway Los Angeles, California F O R M 1 3 0 2 2- fl 2 NO E N V E L O P E R E Q U I R E D : > ; L v , - U 'V-l * ' 1 5 5 V- ; RELIANCE INSURANCE COMPANIES LOS ANG E L E S BRANCH OFFI CE, 548 S. KI NGS L EY DRI VE, LOS ANGELES, CALI FORNI A 90005 TEL: DUNKI RK 5-7171 September 28, 1964 ^Armstrong Cork Company, 5983 Smithway, Los Angeles 22, C a l i f . Re : Claim No: 91-C-436249 Em ployer: Armstrong Cork Company D/ !nj u r y : Ju n e , 1950 Employee: Edward Novak Gent!emen: Mr. Edward Novak has f i l e d an A p p l i c a t i o n f o r H ea rin g , naming your company as h i s employer d u rin g the y e a r s 1950 and 1951, and c l a i m i n g t h a t as a r e s u l t o f h i s employment by you, and many o th e r employers o ver the y e a r s , t h a t he developed a c o n d it io n which was i n d u s t r i a l in c a u s a t i o n , and he seeks to re c o v e r from us as your workmens compensation in su ra n c e c a r r i e r during that time. As b est we can d eterm ine from the in fo r m a tio n s u p p lie d , Mr. Novak is supposed to have been employed a t your o f f i c e . We, t h e r e f o r e , ask t h a t you check your reco rd s and determine i f you have a re co rd of employment of Edward Novak, and i f so, the e x a c t d ates o f h i s employment, and where his personnel records would be. I f t h i s in fo r m a tio n is o n ly a v a i l a b l e a t yo ur Home O f f i c e in P e n n s y lv a n ia , we would a p p r e c i a t e being n o t i f i e d p ro m p tly, and being a d v is e d to whom we should correspond on t h i s . Your e a r l y l e t t e r r e p l y w i l l be v e ry much appreciated. Reliance Insurance Com pany Planet Insurance Company : . Reliance Insurance Companies 543 S, Kingsley Drive Los Angeles,- California 90005 Gentlemen* ' Attention* Mr. Y. C, McDonald, -A Claim Department. ' i-'-O - ' ' '. - Re* Case 0/ 63 250 S54 ' - Claim Ho. 91-0-436249 <- ' Enrolcyer Armstrong Cork Company D/lnjury Juno, 1950 - .. Employee Edvard Novak ; Manager four letter of September 28, addressed to our office in Los Angeles, *'' has been referred to us for attention. '" , .. - - We regret ve cannot give you a record of employment for Mr, Novak for the years 1950 and 1951, as under our Retention of Records Schedule only records for the past ten years are kept, Mr, Novak did not work for Armstrong Cork Company or Armstrong Contracting and Supply Cor poration during the past ten years. ' . . . . According to copy of an Application we received from the Industrial Accident Commission of the State of California, the period of employ ment involving Hr. Novak is 1940 to December, 1956. Iron January 1, 1940 to January f, 1952 the contracting operations of Armstrong Cork Company were insured by Standard Accident Insurance Company' As of January 1 , 1952 the insurance was carried by Travelers Insurance Com pany, up to and including December, 1956, - . . . Armstrong Contracting and Supply Corporation is a named defendant even though the period of employment Involved is prior to the formation of that company, which was on January 1 , 1953, Yeiy truly yours, Mabel E. Barnet ; Insurance Department M. K. Bare, Jr,, Employee Relations M. C. Sweet, AC&S, 4340 District Blvd., Los Angeles G. B. Sauer, Floor Div., Los Angeles ; l':: rr :>h - f.\ "v '"i` v i TH E T H V ELER S THE TRAVELERS INSURANCE COMPANY T H E TRAVELERS INDEMNITY COMPANY CLAIM DEPARTMENT F r a n k O . M e n .n e n , M a n a g e r ' a L0S ANGELES OFFICE 3 <>0 0 W i l s h i r e B o u l e v a r d Los A n g e l e s , C a l i f o r n i a 90005 Telephone: 381-2525 O c t o b e r 8, 196I|. Re: Edward Novak vs. Armstrong Contracting & Supply Co Armstrong Cork Company IAC Case #63 LA 2$0-Q$l Armstrong Cork Company L a n c a s t e r , Pa, I 760I4. Attention: Wallace B. Hofferth Assistant General Manager Insurance Department Gentlemen: Vie a c k n o w l e d g e r e c e i p t of y o u r S e p t e m b e r 11, I 96I4. letter and enclosures. We will represent your ih interest at the forthcoming hearing. i/ It will be necessary for you to supply us with employ ment information which should include the date of hire, actual place of employment, occupation and date of t e r mination. It is our further understanding that Armstrong Contracting _and S u p p l y is a s e p a r a t e e n t i t y b u t t hat w e c a n o b t a i n employment records through your office. In other words, we will need the same information by Armstrong Contracting and S upply as for A r m s t r o n g C ork Company, If vie are i n error, k i n d l y a d v i s e to w h o m we s h o u l d d i r e c t these inquiries. <TAT > V T / 1 0 0 % i YEARS j V orUiLRICE PSCIICIiCI I*Y 1HO1 - 1 0 0 4 .V JB :mt HOME OFFICE: HARTFORD, CONNECTICUT VISIT THE TRAVELERS EXHI8IT XT THE fiW GRK WPSl S FAiR 261-0216 CABLE ADDRESS ALEXCANO TELETYPE PG 891 ALEXAN D ER AGENCY, INC. IN SU RA N CE-W O RLD WIDE SINCE 1 8 5 3 3 1 6 FOURTH AVENUE PITTSBURGH, PA. 1 5 2 2 2 October 20, 1964 (Tuesday) Armstrong Cork Company Lancaster Pennsylvania Attention: Mr, Hofferth Re: Edward Novak Gentlemen: Enclosed you will find a copy of my letter addressed to the Reliance Insurance Company,who are successors to the Standard Accident Insurance Company. Very truly yours, BRSteh Enclosure S' >' /' / A / Z / / Beverly R. Shriver ' -a ' O U R S E C O N D C E N T U R Y OF" I N S U R A N C E S E R V I C E * '*' .~ v. " . " , " ' V _ October 21/1964 Hr, Joseph Bilchak-'; - /' .Hearing Representative . The Travelers -/ . y--- p-.: '' 3600 Wilshira Boulevard: Los Angeles, California 90005 Dear Sir y ' y . V>; 4. *. ! * S. ~ * r~- - . jr i*sr ,V 1 y .Res ' Edward-Nq?a^ye'^/^'v* / ' :p y ' y / . y y 7 - f " ./ '/y /';%'/ Armstrong Contracting and Supply, C o r p o r a t i o n / 3 \ 1 ' O'-'-.".; ` .-y; " Armstrong'Cork'Company - 'r ;y.y, IAC Cas #63 L 250r854i^ / / / l/ / / ; / / ; ^ " i y / y . / / / / . y / ; ; ^ 'We have'your letter, of .October B. ptfV.'/.>'/..;/yy '*/>yp/yf-i- C - : i- /. According to copy.of an Application we received from the Industrial;.':''- Accident .Commission of the. State of California, the,'period of employ-'-'' ment involving Hr. Novak i s .1940. to December,- 1 9 5 6 , ; .-.l'-''/ ,; y * y Hr, Novak did not work.for Armstrong Cork Company nor, Armstrong * y ; V v Contracting and'Supply Corporation during the past ten years, We regret-, we cannot giv8''you a record o f .employment previous to that, as,under our.. Retention of Records Schedule only records for ,the past ten years a r e . ; kept. --..y`y; - P / y P; V . - . p ' :: ' V-- '. " ;. " Prom January 1,194-0 ..to.January 1, ,1952 contracting -operations o f .'.. ' Armstrong Cork Company were insured by Standard Accident Insurance Company} now the Reliance ..Insurance. Company. . As of. January 1, 1952 in- '; surance 'was'carried by ,The Travelers.up!,to_ ad.,including December, 1956. - . i ''a -* - v.*- ,, . - vj-Vy ~~ . . ' . - * ' Armstrong Contracting and Supply, Corporati on is a,named defendant even- though t h e 'period of, employment involved is. prior, to the formation of that company, which'was on January 1, 1953. ' .On this date they'assumed the contracting operations of Armstrong Cork Company. ' y. . v.'P -, y ' K . Very .truly yours, .. {t* - ' v. ' febei E Barnet . :. " Insurance Department ^ i BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as Fiberglas Engineering Company; et al and RELIANCE INSURANCE COMPANY, a corporation; THE TRAVELERS INSURANCE COMPANY, a corporation; ARGONAUT INSURANCE COMPANY, a corporation; INDUSTRIAL INDEMNITY COMPANY, a corporation Defendants Case No, 63LA 250 85^ ORDER JOINING PARTIES DEFENDANT GOOD CAUSE APPEARING THEREFOR: IT IS HEREBY ORDERED THAT RELIANCE INSURANCE COMPANY, a corporation THE TRAVELERS INSURANCE COMPANY, a corporation ARGONAUT INSURANCE COMPANY, a corporation INDUSTRIAL INDEMNITY COMPANY, a corporation be joined as parties defendant in the above-entitled cause. WILLIAM KAPLAN Referee INDUSTRIAL ACCIDENT COMMISSION M a r c h 8, 1965 NAME AND ADDRESS OF PERSONS SERVED 3/8/65 See attached list for service. 1. w . mar (Signature of person'servihg~notice) Edward Novak, 4055 Tujunga Ave;, North Hollywood W i l l i a m T. Hays, 6331 H o l l y w o o d Blvd., L A 9 0 0 2 8 T h o r p e I n s u l a t i o n Co,, 2741 S. Yates, LA 9 0022 Marine Engineering Co* aka Fiberglass Engineering Co., 5 9 3 3 Telegraph Rd., LA 90022 Reece Insulation Co., 4563 Valley Blvd., LA 90032 Plant Insulation Co., aka Thorpe Insulation Co., 27^1 S. Yates Ave., LA 90022 Jackson Hopkins Co., Box 490, Bakersfield Armstrong cork Co,, 5037 Patata St., south Gate Att: Ronald K. Wilson Armstrong Contracting & Supply Co., 4340 District Blvd,, LA Plant Asbestos Co., 1540 W. 9th, Long Beach Pacific Employers Ins. Co., 4050 Wilshlre Blvd., LA 90005 F i r e m a n ' s F u n d Ins. Co., B o x 2323. L A 9 0 0 5 4 Att: H. P. S h o o p (2cc) The Aetna Cas. & Surety Co., 2404 Wilshlre Blvd., LA 90054 The Travelers Ins. Co., 36OO Wllshire Blvd,, LA 90005 R e l i a n c e Ins. Co,, 548 S. K i n g s l e y Dr., LA 9 0 0 0 5 Weingand, K e n d i g & Stockwell, 6ll S. Catalina, LA 90005 * M c C o n n e l l & C r a m o l i n e , 25 7 S. S p r i n g St., LA 9 0 0 1 2 Herlihy & Herlihy, 412 W. 6th St., LA 90014 Marine Engineering Co., 14301 Ainsworth, Gardena Argonaut Ins. Co., 1001 Wilshlre Blvd., LA 90017 Industrial Indem. Co., Box 2252, LA 90054 Allen, P e t e r s e n & Mansell, 505 S. Virgil, LA 90058 Copy of application and Joinder filed 8/20/64 served. O INDUSTRIAL ACCIDENT COMMISSION STATE OF CALIFORNIA a -< -s, 1 'y' t CaseNo_ _ vs. *'/%^r*' T*.T-'Kj VA.v *Xv,S^ViS0-*A^--^v-5*iV*j 4V # .5'-yrVrgVpijJ -J..T'"J1fc-ir-Sy SI ^V^ T T ^ , C ^ T ' & A S T Applicants fe-t it N otice of Time and Place of Further H earing Defendants . ` . ... NOTICE TO ALL PARTIES ' ' '- You are hereby notified that further hearing will be held in the above-entitled action at 4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADWAY LOS ANGELES, CALIFORNIA . if 4v _ ^ . t 2 r^*,,4, v sa, #f*,, ^ c.fii. w*,--"" f-*----g-, S Dated at: LOS ANGELES v'A - Vi5 IN D U STR IA L A C C ID EN T COMMISSION N O TE : C O N TIN U A N C ES A N D FU R TH ER HEARINGS ARE N O T FAVORED. -!:.? AVV ffftT-5i r"**# v*" -TSVSw-ft '-Vti: *t.'ti*r DATE hs?r^3 ^ W rc-r- r?* Form 400-L (rev.2-s4) S' /t t ^ t-v _3<772-02 OOM OS* dd) L r3 if T TU J ' -- / N ' '> INDUSTRIAL ACCIDENT COMMISSION STATE OP CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as Fiberglas Engineer ing Company; et al Defendants Case No. 63LA 250 854 Notice of Time and place of Further Hearing NOTICE TO ALL PARTIES You are hereby notified that further hearing will be held in the above-entitled action at 4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADWAY, LOS ANGELES, CALIFORNIA June 22 & 23, 1965 9:00 A.M. 2 days Dated at; LOS ANGELES INDUSTRIAL ACCIDENT COMMISSION NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED, NAME AND ADDRESS OF PERSONS SERVED Edward Novak, 4055 Tujunga Ave., North Hollywood W i l l i a m T. Hays, 6331 Hollywood Blvd., LA 90028 T h o r p e I n s u l a t i o n Co., 2741 S. Yates, LA 90022 Marine Engineering Co. aka Fiberglass Engineering Co., 5 9 3 3 T e l e g r a p h R d ., LA 9 0 0 2 2 C l a r k B. R e e c e dba R e e c e I n s u l a t i o n Co., 4 5 6 3 V a l l e y Blvd., LA 9 0 0 3 2 plant insulation Co. aka Thorpe Insulation Co., 2741 S. Yate Ave., LA 90022 Jackson Hopkins Co., Box 490, Bakersfield Armstrong Cork Co., 5037 Patata St., South Gate A t t : R o n a l d K- W i l s o n A r m s t r o n g C o n t r a c t i n g & S u p p l y Co., 4 3 4 0 D i s t r i c t Blvd., LA 90058 Plant Asbestos Co., 1540 W. 9th, Long Beach Marine Engineering Co., 14301 Ainsworth, Gardena Pacific Employers Ins. Co., 4050 Wilshire Blvd., LA 90005 F i r e m a n ' s F u n d Ins, Co., Box 2323, LA 90054. Att: H. P. S h o o p Standard Accident Ins. Co. successor to Reliance Ins. Co., 548 S. Kin g s l e y Dr., LA 90005 Industrial Indem. Co., Box 2252, LA 90054 Guarantee Ins, Co., 1671 Wilshire Blvd,, LA 90017 M c C o n n e l l & C r a m o l l n e , 257 S. S p r i n g St., LA 9 0 0 1 2 H e r l i h y & Herlihy, 412 W. 6th St., LA 90014 Spray, Gould & Bowery, 1671 Wilshire Blvd., LA McLaughlin, Evans, Dalbey & Cumtning, 6725 Sunset C l o p t o n & Penny, 639 S. S p r i n g St,, LA Copy of application and Joinders filed 8/20/64 & Blvd., 3/ 8/65 LA 90028 served. 1 .w.mar /Si person" serving notice) ' / / INTER OFFICE COMMUNICATION A/m strong CONTRACTI Accideat Conmlaaioa hearing for a former employee, CH A*! Stoksly, Saa F r a n c i s c o ip 0 FORM 1501 Printed in U .S .A . Aw: EFORfe 'THE I N D U S T R I A L A C C I D E N T C O M M I S S I O N OF THE STATE OF CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as FIBERGLAS ENGINEERING COMPANY; et al and FIBREBOARD PAPER PRODUCTS CORP. , a corporation; PACIFIC INDEMNITY COMPANY, a corporation JACKSON PACKING CO., INC., a corporation Defendants Case No. 63LA 250 854 ORDER JOINING PARTIES DEFENDANT GOOD CAUSE APPEARING THEREFOR: IT IS HEREBY ORDERED THAT . FIBREBOARD PAPER PRODUCTS CORP. , a corporation PACIFIC INDEMNITY COMPANY, a corporation .. JACKSON PACKING CO., INC., a corporation be joined as parties defendant in the above-entitled cause. INDUSTRIAL GORDON W. WINBIGLER Referee ACCIDENT COMMISSION Name and address of persons served See attached list for service. Date - s 1. w . mar (Signature of person serving notice) E d w a r d Nov a k , 4 0 5 5 T u j u n g a A v e ., N o r t h H o l l y w o o d - Wi l l i a m T. Hays, 6331 Hollywood Blvd., LA 90028 Marine Engineering Co. aka Fiberglas Engineering Co, 5933 Telegraph Rd., LA 90022 C l a r k B. R e e e e dba Reece I n s u l a t i o n Co., 4563 Valley Blvd., LA 90032 P l a n t I n s u l a t i o n Co. aka T h o r p e I n s u l a t i o n Co., 274 1 S. Y a t e s Ave., LA 90022 Jackson Hopkins Co., Box 490, Bakersfield Armstrong Cork Co., 5037 Patata St., South Gate Att; R onald K. W ilso n A r m s t r o n g C o n t r a c t i n g & S u p p l y Co., 4 3 4 0 D i s t r i c t Blvd., LA 90058 Plant Asbestos Co., 1540 W. 9th, Long Beach M a r i n e E n g i n e e r i n g & S u p p l y Co., 941 E. 2nd St., LA 90012 Flbreboard Paper products Corp., 475 Brannan St., San Francisco 94119. Att: M i s s D. Hanson, Mgr . E m p l o y e e Ins. Dept. Jackson Packing Co., Inc., Box 490, Bakersfield Pacific Employers Ins. Co., 4050 Wilshire Blvd., LA 90005 Fireman's Fund Ins. Co., Box 2323, LA 90054 Att: H.P.Shoop Reliance ins. Co., successor to Standard Accident Ins. Co., 5 48 S. K i n g s l e y Dr., LA 9 0 0 0 5 Industrial Indem. Co., Box 2252, LA 90054 Guarantee Ins. Co., 1671 Wilshire Blvd., LA 90017 Pacific Indem. Co., Box 3099, LA 90054 M c C o n n e l l & Cramollne, 257 S. S p r i n g St., LA 90012 Herlihy & Herlihy, 412 W. 6th St., LA 90014 Spray, Gould & Bowers, 1671 Wilshire Blvd., LA 90017 McLaughlin, Evans, Dalbey & Cumming, 6725 Sunset Blvd., LA 90028 C l o p t o n & Penny, 639 S. S p r i n g St., LA 9 0 0 1 4 Brobeck, Phleger & Harrison, 111 Sutter St., San Francisco 9^104 C o p y of a p p l i c a t i o n and J o i n d e r of 8 / 2 0 / 6 4 & 3/ 8/65 served. / INDUSTRIAL ACCIDENT COMMISSION STATE OF CALIFfcilA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as FIBERGLAS EN G I N E E R I N G COMPANY; et al Defendants Cas e No. 63LA 25o' 854 NOTICE OF TIME AND PLACE OF FURTHER HEARING NOTICE TO ALL PARTIES You are hereby notified that further hearing will be held in the above-entitled action at 4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADWAY, LOS ANGELES, CALIFORNIA J a n u a r y 11 & 12, 1966 9 : 0 0 A.M. 2 days Dated at: LOS ANGELES NOV 1 5 1965 INDUSTRIAL ACCIDENT COMMISSION NOTE; CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED. NAME AND ADDRESS OF PERSONS SERVED See attached Joinder for service. 1. w . mar (Signature of person serving" notice) / From M.C Sweet, Los A n g e l e s Subject E d w a r d N o v a k Former Employee Attached to thi s communication is a notice form the Industrial Accident Commis sion, State of California* indicating that a farther hearing will be held for Edward Novak, former employee CH FORM 1505 Printed in U .S .A . m ?v - > ; m A h :<>.'> h v - y y y y y hyii " -n -.u v r u - y y ^ -yy - m --.yy;-. n y y y y ` h y y lyj> y ; y y y y y y iy y y i y . 7.hr.f% y y t y y y s * y--'- v y y y y b - v : y > - y.-~*. ` ;; hyC-vh y ,,' r , Vv ;v - f / . y t y .3. -.h.; f y - J' ~V. iv ' - . >- - - : r 1 y -` -,w- ---V; - "'-`Ay'L 11-I;/-,'-*.I -' I - .V . ' r - / i N y y i y - r 1 1 1 ... hy; yV 1 1,^ ' ` ' ' > r - 1 -U . * - ' ; -:-- i y ;-^'-- y'-' A. ' . - ;. >-- A . 1 / ; , y :y y y . y i y y .y y : v y t y A- w -y , :":xZ - . i y i ' - : . y y y - - h ;:.; . ' A- i m i w yy y= ^ ^ y,y;y yy : y h y y . ; y y y n . ; , y - y y y vyrnmn y y'vy '. y" . 1 ii^y-mlVihhAllli^yl./^-hyhyhv-yh-^yyr^yiro'y y y y y r y y i y y -A-mo;x^>::cri3-yy^y^e^yyj3>;nryyyy.yyi-v.v^y?;y;J-yyiwrh^ y t f y y y y y - y y - h. ,i-y. . .- y y,*. y>, 1y y*"y y y n y y y-..-Vyr' y y . y' h>- ^ y y y m 4-'- y - -' y r i,- y' . ^ ' y i y y t. .y,, y - y ;. yy;yy:-y.y y uy;--;- ^'>y h: y y, v. 5 ` ./ ' INDUSTRIAL ACCIDENT COMMISSION STATE OP CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as FIBERGLAS E N G I N E E R I N G COMPANY; et al Defendants Case No. 63LA 250 854 NOTICE OF TIME AND PLACE OF FURTHER HEARING NOTICE TO ALL PARTIES You are hereby notified that further hearing will be held in the above-entitled action at 4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADWAY, LOS ANGELES, CALIFORNIA J a n u a r y 11 & 12, 1966 9:00 A.M. 2 days Dated at: LOS ANGELES NCV 1 5 19S5 INDUSTRIAL ACCIDENT COMMISSION NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED NAME AND ADDRESS OF PERSONS SERVED See attached joinder for service. 1. w . mar (Signature of person seFvIng notice) BEFORE TH INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA EDWARD NOVAK Applicant vs, MARINE ENGINEERING COMPANY, also known as FIBERGLAS ENGINEERING COMPANY; et al and FIBREBOARD PAPER PRODUCTS CORP. , a corporation; PACIFIC INDEMNITY COMPANY, a corporation JACKSON PACKING CO., INC., a corporation Defendants Case No; 63LA 250 85^ ORDER JOINING PARTIES DEFENDANT GOOD CAUSE APPEARING THEREFOR: IT IS HEREBY ORDERED THAT FIBREBOARD PAPER PRODUCTS CORP., a corporation PACIFIC INDEMNITY COMPANY, a corporation .. JACKSON PACKING CO., INC., a corporation be joined as parties defendant in the above-entitled cause. INDUSTRIAL GORDON W . WINBIGLER Referee" ACCIDENT COMMISSION NjV 1 5 U 85 Name and address of persons served See attached list for service. Date 5 .955 1. w . mar (Signature- T persorTlTerving notic Edward Novak, 4055 Tujunga Ave., North Hollywood W i l l i a m T. Hays, 6331 Hol l y w o o d Blvd., LA 90028 Marine Engineering Co. aka Fiberglas Engineering Co., 5 933 T e l e g r a p h R d ., L A 9 0 0 2 2 C l a r k B. R e e c e dba R e e c e I n s u l a t i o n Co., 4563 V a l l e y Blvd., LA 90032 . - P lant I n s u l a t i o n Co. a k a T h o r p e I n s u l a t i o n Co., 2 7 4 1 S. Y a t e s Ave , L A 9 0 0 2 2 Jackson Hopkins Co, Box 490, Eakersfield Armstrong Cork Co., 5037 Patata St., South Gate Att; Ronald K. W i lso n Armstrong Contracting & Supply Co., 4340 District Blvd., LA 90058 Plant Asbestos Co., 1540 W. 9th, Long Beach M a r i n e E n g i n e e r i n g & S u p p l y Co., 941 E. 2nd St., LA 9 0 0 1 2 Fibreboard paper products Corp., 475 Brannan St., San Francisco 94119. Att: Miss D. Hanson, Mgr. Employee Ins. Dept. Jackson Packing Co., Inc., Box 490, Bakersfield Pacific Employers Ins. Co., 4050 Wilshire Blvd., LA 90005 F i r e m a n 's F u n d Ins. Co., B o x 2323, LA 9 0 0 5 4 Att: H . P . S h o o p Reliance Ins. Co,, successor to Standard Accident Ins. Co, 548 S. K i n g s l e y Dr., LA 9 0 0 0 5 Industrial Indem. Co., Box 2252, LA 90054 Guarantee Ins. Co, 1671 Wilshire Blvd,, LA Pacific Indem. Co., Box 3099, LA 90054 90017 M c C o n n e l l & Cramo l i n e , 257 S. S p r i n g St,, LA 90012 Herlihy & Herlihy, 412 W. 6th St,, LA 90014 Spray, Gould & Bowers, 1671 Wilshire Blvd, LA 90017 McLaughlin, Evans, Dalbey & Gumming, 6725 Sunset Blvd., LA 90028 C l o p t o n & Penny, 6 3 9 S. S p r i n g St., LA 90014 Brobeck, phleger & Harrison, 111 Sutter St., San Francisco 94104 C o p y of a p p l i c a t i o n an d J o i n d e r of 8 / 2 0 / 6 4 & 3/ 8/65 served.  int er/ _________________ _ / ofTice COMMUNICATION To J . E . Z e l l e r , L a n c a s t e r From 'if.C. S w e e t , K o s A n g e l e s Subject E d w a r d N o v a k ~ -Former E m p l o y e e (Arm strong CONTRACTING Jan u a r y 11, 1966 Attached is f u r t h e r c o r r e s p o n d e n c e r e g a r d i n g the i n s u r a n c e claim of the above listed former employee. CH FORM 1501 printed in U .S . . i ' 0-U`jX V p dOO oa ; i A dOO . ..L-L*OfJ3X ;__ WILLIAM T. HAYS HAROLD U GREENE WILLIAM T. H A Y S ATTORNEY A T 1_AW urne tat-* QUJkANTY suu_ojRa aat HouLYwooo H o u u v A n o HOLLYWOOD, CALIFORNIA - 8005 HOLLYWOOD 2-0331 January 3, 1965 In d u s tr ia l A c c id e n t C o m m ission 107 S outh B roadw ay - Room 4107 Los An g e le s, C a lifo rn ia . ' - . : Re: E dw ard N ovak vs. M a rin e E n g in e e rin g Com pany, aka F ib e rg la s E n g in e e rin g Com pany, e t a l ' IAC C ase N o. 63 LA 2 5 0 -85 4 G e n tle m e n : \\ ' The a tte n tio n o f th e C om m ission is r e s p e c tfu lly d ire c te d to th e case o f J. W. R ile y vs. Jo h n s -M a n v ille , e t a l, in d u s tria l A c c id e n t C o m m issio n case no. 57 LA 1 8 2 -8 3 5 . In th e R ile y case, p e rio d s o f em ploym ent w h ic h la rg e ly p a r a lle l th o s e o f a p p lic a n t a re s e t o u t w ith a d m issio n s o f co ve ra g e and p o lic y num bers, and w ill be o f s u b s ta n tia l c la rify in g va lu e to a ll defendants > : re g a rd in g coverage p ro b le m s. I t is su gg e ste d th a t fo r the p u r p o s e o f c o v e r a g e , t h e r e c o r d o f t h i s c a s e b e m a d e a v a i l a b l e ; to the p a rtie s defendant. . r j, , ! R e s p e c tfu lly , ! ; J i ByH a r o l d L . G r e e n e A tto rn e y a t Lav/ W TH /H LG /h Copy a ll p a rtie s o f record p e r attached i >tg*rr .'- j OX iLJl'.OjX.) W* J f , i \ 3AdOO ^ Edward Novak, 4055 Tujunga Ave., North Hollywood Wi l l i a m T. Hays, 6331 H o llywood 31 vd., LA 90028 'Marine Engineering Co.; aka Fiberglas Engineering Co;, 5933 T e l e g r a p h Rd., LA 90022 Clark B. Reece dba Reece I n sulation Co., 4563 Valley Blvd., LA 90032 plant insulation Co. aka Thorpe Insulation Co., 2741 s . Yates A v e ., LA 90022 Jackson Hopkins Co., Box 490, Eakersfield --- ArmAstttr:ongR oCnoarlkd CKo..,W 5i l0s 3o 7n Patata St., South Gate " ...... " ' --- 75LJ0-Armstrong ^Contracting & supply Co,, 4340 District Blvd,, LA 90058 Plant Asbestos Co., 1540 W. 9th, Long Beach * Marine Engineering & Supply Co,, 94l E. 2nd St,, LA 90012 *.Pibreboard Paper products Corp., 475 Brannan St., San Francisco 94119, Att: Miss D. Hanson, Mgr, Employee Ins. Dept, * Jackson packing Co., Inc., Box 490, Bakersfield Pacific Employers Ins. Co,, 4050 Wllshire. Blvd., LA 90005 Fireman's Fund Ins, Co., Box 2323, LA 90054 Att: H.P.Shoop Reliance Ins. Co., successor to Standard Accident Ins, Co,, 548 S. Kingsley Dr., LA 90005 Industrial Indem. Co., Box 2252, LA 90054 Guarantee Ins. Co., 1671 Wllshire Blvd., LA 90017 * Pacific Indem, Co., Box 3099, LA 90054 , McConnell & Cramollne, 257 S. Soring St,, LA 90012 Herlihy & Kerllhy, 4 1 2 W. 6th St., LA 90014 S p r a y , G o u l d & B o w e r s , 1671 W l l s h i r e B l v d , , LA 90017 McLaughlin, Evans, Dalbey & Gumming, 6725 Sunset Blvd., LA' 90028 , !! Clopton & Penny, 639 S. Spring St., LA 90014 * B r o b e c k , p h l e g a r & H a r r i s o n , 111 S u t t e r S t . , S a n F r a n c i s c o 94104 1 1 . r J.- From Subject M.C. Sweet, Los Angeles Edward Novak - Former Employee Attached to t h l3 ':r' communication you will find a notification f r o m the Industrial Accident Commission, State of California, setting a time and p l a c e of f u r t h e r h e a r i n g f or the above indicated former employee. CH 4 FORM 1501 Printed in U .S . . is - s ;  I S' ( 1 WORKMEN'S COMPENSATION APPEALS BOARD 2 STATE 0? CALIFORNIA 3 CASE NO, 63 LA 250-85^ 4 5 EDWARD NOVAK, ) 6 Applicant ) 7 vs, ) 8 MARINE ENGINEERING COMPANY, also ) known as Fiberglas Engineering 9 Company; CL A R K B. REECE, doing ) business as Reece Insulating 10 C o m p a n y ; PLANT? I N S U L A T I O N C O M P A N Y , ) ORDER APPROVING also known as T h o m Insulation 11 Company; JACKSON-HOPKINS'COMPANY; ) COMPROMISE AND RELEASE ARMSTRONG CORK COMPANT; ARMSTRONG 12 CONTRACTING & SUPPLY COMPANY; ) PLANT ASBESTOS COMPANY; MARINE 13 ENGINEERING & SUPPLY COMPATI; ) PLANT RUBBER AND ASBESTOS WORKS; 14 JACKSON PACKING COMPANY, INC,, a ) corporation; FIBREBOAR) PAPER 15 PRODUCTS CORPORATION, a corporation, ) lo 17 PACIFIC EMPLOYERS INSURANCE COMPANY, ) a corporation; FIREMAN'S FUND 18 INSURANCE COMPANY, a corporation; ) GUARANTEE INSURANCE COMPANY, a 19 corporation; INDUSTRIAL INDEMNITY ) COMPANY, a corporation; RELIANCE Or I N S U R A N C E C O M P A N Y , S u c c e s s o r f-o ) Standard Accident Insurance } 21 Company; ARGONAUT INSURANCE COMPANY, ) a corporation; PACIFIC INDEMNITY 22 COMPANY, a corporation, ) 23 Insurance Carriers 24 25 26 The parties to the above-entitled action having filed a j | 27 C o m p r o m i s e and R e l e a s e h e r e i n , on .August 8, i 9 6 0 , s e t t l i n g thi s c a s e ; 28 for $ 5 ,500,00, and r e q u e s t i n ~ 01-o0. +0- 4l b+- be a p p r o 29 IRA RATNER, Referee, having considered the ent 30 said C o m p r o m i s e and R e l e a s e , n o w finds that it 1 A 33 = Ot il 1 GOOD CAUSE APPEARING THEREFOR: 2 IT IS O R D E R E D that said C o m p r o m i s e and R e l e a s e be, and is 3 hereby approved, and the proceeds paid as follows: 4 TO APPLICANT: 5 $ 1 , 9 ^ 0 * 0 0 b y P a c i f i c E m p l o y e r s I n s u r a n c e Co, S V Pb Oe*Aj A -* VU C~ o5, 4o-> w^ >-. 7 ^ F $300,0Q b y R e l i a n c e Insurance Co, D 8 $300.00 by Industrial Indemnity Co. 9 $250.00 b y A r gonaut Insurance Co. 10 $150.00 by Pacific Indemnity Co. -X11J- $ 1 5 0.00 b y F i r e m a n 's Fund Insurance Co. 12 $150.00 b y G u arantee Insurance Co. 13 T O V I L L I A M T , HAYS, as a t t o r n e y 's fee: 14 $550*00 b y Pacific Employers Insurance Co. 15 18 IRA RATHER Referee /s/ 8E T Y -00 17 'WORICIEN `S C CMPEIi SAT 10 II A P P E A L S B O A R D 18 19 20 21 22 23 24 25 n a m j ar l o o j w j E. r* * r 'r z r r s 'D m t a `w- *! 2 .x. E O ' - t J. i ^-L 26 August 18, 1066 t, L) 27 28 SERVED ON ALL PARTIES LISTED ON OFFICIAL ADDRESS RECORD, 29 A u g u s t 1 8 , i960 By S, M A T 3U1I0T0 30 _2~ M33 *** ***< * rifl^ U rcaiter H .C . 5 v * t, to i A ng elas 4v%fd J i d v a k f o r m e r Em ployee August 19, 1966 IT A l l * < h < d i s a copy o f the f i n a l r u lin g by the worlfrn , Al ap ^t -^stl s Board, S em p loyee, t a t e of C a lifo rn ia , ' c o n c e rn in g ncerning -he the 7 3 C mP e n s a t ln above lis te d Ol i i -r. ' 'i V IL //< ? } CODE F/ u Ja r c i. NAME MED HOSP X -R A Y $ $ TEM P: DAY WK OTHER E X PL A N A T IO N CK NO P.D . FROM THRU AMT. /y^' C L A IM NU M B P. TOTAL RESERV / & O * 4 "' " l g -------------* * yi-- 1S 7 ? * ADD1L. IN F O R M A T IO N 2 z O II