Document JNqXkQnnOmJbey1bQdn7k7exe

FILE NAME: Insulators Workers' Comp Claims (IWC) DATE: 1961 DOC#: IWC002 DOCUMENT DESCRIPTION: Claimant - Harding, Clifford P. * i * it BALTIMORE NE'Jjf YORK (> CLARKSBURG TULSA STL LO U IS . CHICAGO Lt)S ANGELES At l a n t a PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPFftA .AlXA^SIKRi'^ INCORPORATED INSURANCE V average aojusters c o n s u l t i n g a c t u a r i e s 2225 NORTH CHARLES STREET, BALTIMORE 18, MD. J TELEPHONE TUXEDO 9-A3CA B ELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" February 27, 1962 Mr. William L. Hughes,.Manager Insurance Department Armstrong. Cork Company Lancaster, Pennsylvania. Travelers Policy No. RUB-4490459 ,i I I Dear Sir:- please note disposition made of the following claim Date of Accident: January 9, 1955 Claimant: Clifford P. Harding Location: Sacramento, California Claim No.: g 9527634 Disposition: 50.57 Perm. Partial Remarks: Indicate Whether: Workmen's Comp, x_____ Auto Liability B.I. P.D.___ General Liability B.I. P.D. sg Very truly yours, ALEXANDER & ALEXANDER INC. LOSS DEPARTMENT INTE OFFICE COMMUNICATION To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Clifford P. Harding Claim No. 60 SF 193-^5^ CONTRACTIN September 29> 19^1 Attached for your information is the order approving compromise and release on the above subject man who had made a claim for Asbestosis. FORM 1501 Printed In U.S.A. Re : CLIFFORD P. HARDING - Claim No. 60 SF 193-S51* By AMERICAN MOTORISTS INSURANCE COMPANY By AETNA CASUALTY & SURETY COMPANY By GUARANTEE INSURANCE COMPANY By ZENITH NATIONAL INSURANCE COMPANY By PACIFIC EMPLOYERS INSURANCE COMPANY By ASSOCIATED INDEMNITY CORPORATION By STATE COMPENSATION INSURANCE FUND $ 84.28 370.81 286.54 33.71 101.13 33.71 1934.72 $`3`3 0 0 . IT IS FURTHER ORDERED that STATE COMPENSATION INSURANCE FUND deduct the sum of $352.00 from its contribution to be paid directly as follows: $300.00 to Smith, Parrish, Paduck & Clancy as an attorneys' fee; $22.00 to Smith, Parrish, Paduck & Clancy for transcript of the deposition; $30.00 to Norbert Frey, M.D. A. H. NELSON, Referee INDUSTRIAL ACCIDENT COMMISSION AHN:mlm Piled and served on: Clifford P. Harding, 1407 Howe Ave., Sacramento 25 Plant Asbestos Co., 1300 - 64th St., Emeryville J. T. Thorp & Sons, Inc., 1351 Ocean Ave., Emeryville Metalclad Insulation Co., Inc., P.0. Box 17 8 , Torranc Caw Insulation, 3600 - 20th Ave., Sacramento Dutton Asbestos & Supply Co., 532 Natoma St., b* Armstrong Cork Co., l8l4 Ogden Drive, Burlingame , Coast Insulating Products Corp., 2684 Lacy Street, Los Ange 3 h F Braun & Co., 1000 South Fremont Ave., Alhambra .Owens-Corning Fib4rglas Corp., Marin^Engineering0^* Supply* . / 941 E a L 'Second St. Los Angeles Fluor Maintenance, Inc., 2500 South Atlantic Blvd., Los Angeles 22 M. R. Carpenter, Inc., 907 Front St., Sacramento 7 Western Asbestos Co., 675 Townsend St., SF 3 Industrial Indemnity Co., 350 Sansome St.,SF sp . California Casualty Indemnity Exchange, 550 Kearny St., a* ^andaS ccWent Ins. Co., 8 W West San Bruno Ave., San Bruno Travelers Ins. Co., 550 California St., SF Argonaut Ins. Co., 550 California St., SF American Motorists Ins. Co- #,SF Aetna Casualty & Surety Co., 220 Montgomery S.., SF Guarantee Ins. Co., 550 Kearny St.,SF Z e n i t h National Ins. Co., 582 Market - t . , SF Pacific Employers Ins. Co., 244 Pine St., Si Associated Indemnity Corp., 332 Pine St., at State Compensation Ins. Fund - Personal Service -2- CLIFFORD P. HARDING - Claim No 60 SF 193-85^ Re : Filed and served on: continued , Oakland S I * . Farrish, Faduck* g - n f . * 1 ~ i al Center BIS. Gordon Sedgwick^De tert^ M o ran*1^Arnold, 100 Bash S t ,, SF - Attn: Keith Mullen Se Filippi, 3 1 5 Montgomery St., SF j. Patrick Goodwin } Ul Sutter St SF -3- CLIFFORD P. HARDING A. H. NELSON, Referee September 21, 19^1 vs. PLANT ASBESTOS CO., J. T. THORP & SONS, INC., et al Claim No. 60 SF 193-85^ Inj: Asbestosis REPORT OF REFEREE ON ORDER APPROVING COMPROMISE AND RELEASE______ , Asbestos worker, b o m February 28, 18 9 6 , claims asbestosis as the result of industrial numerous employers going back some 15 years. ^Jf^fuding of_ctate localities, heShSsPa S S t o ^ ioftS p p m x i m a S l y n 30ayears of intermittent exposure to asbestos dust. The record shows that applicant continu^ ^ r^ UntHi May, 1959, when he was seized with sudden severe ch P * was hospitalized on a diagnosis of coronary evidence of X-rays taken at that time were interpreted as showing evidenc asbestosis. It is now proposed to settle the case by the payment of $3300.00, nothing having been paid heretofore. Concerning the present cause of disability, Dr. Horton C. Hinshaw, Jr., states as follows: ' "The degree of asbestosis evident on X-ray here would not be expected to lead to heart disease, ^ heart disease produced by lung disease is atiet disease which leads to coronary occlusion, which this patien S p S S n t l y Sas had. Consequently, it would be my opinion that his heart disease is a separate condition and not directly related to his asbestosis". On the basis of pulmonary function tests, the doctor concluded S hfs final report that the I S ^ Btf S S " o S r a large degree due to his heart disease and not to asbestosis. Indeed, onSthe basis of diffusion capacity test, g ^ i ing judgment that the asbestosis was so mild as not to be disabli g or productive of any symptoms In an earlier report, Dr. Norbert Frey, on behalf of the applicant had concluded that the patient had a moderate S S rSe of pSionlry fibrosis, which was productive of .some shortness of breath. He expressed no,?pi ? l a S i l i t S 8 industrial contribution to the over-all disability. On the record, the settlement is fair and adequate. nT^pnq-PTTON- Order Approving Compromise and Release to be paid ?o said appiicaS?: l e S $30.00 to Norbert Frey, attorneys' fee of $300.00 and reimbursement costs of *22.00 to be p S I ?o applicant1s attorneys out of the amount payable by State Compensation Insurance Fund. AHN :mlm A. H. NELSON, Referee INTE OFFICE COMMUNICATION To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Industrial Accident Commission State of California Case 6o s f 193-851* Attached is a notice of time and place of further hearing in the above subject case for Clifford P. Harding. I note that we have been served as Armstrong Cork Company, l8lU Ogden Drive, Burlingame. I also note that the Travelers Insurance Company has been served. DJM Form 33377 6-59 Before the Industrial Accident Commission of the State of California CLIFFORD P* HARDING, 60s? 193-854 Case N o .-------------------------------------------------- -- Applicant-- vs. WESTERN ASBESTOS COMPAN?, St al and . _ STATE COMPENSATION INSURANCE FUND, at al. Notice of Time and Place of Further Hearing D e fe n d a n t_* NOTICE TO ALL PARTIES You are hereby notified that further hearing w ill be held in the above-entitled action at 631 J Street - R00 507 Saorassento JUNE 27, I96I 9sQ0 .H. - ALL DAY Dated at: San Francisco, Calif* Kay 1 8 , 19 6 1 ALSO TO COMPLETE CASE JUNE 28, 1961 9*00 X -- ALL DAY " INDUSTRIAL ACCIDENT COMMISSION NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED. SERVICE UPON: Served all parties as per attached list* 5 -1 8 - 6 1 AH F o r m 4 0 0 <r e v . n - s e ) I K K 4-60 40M . t>5ii ~ C il -RD LA-RDw v4-.''iv-.--V- OF PARTIES SERVED s DATE OF SERVICE "l?fletei p , Harding, 1407 Hewr Av*?, Sacrisa-'&ritOi, 25 5" lB6 l !! 'r.h/rapkSh, Fsdduck & Clancy, 501 Financial Center Bitig ,* Oakland 1-, Aitnj Kr, Lewis SI K,, fi. Carpenter.; Ire, 90? Front S t 0 , SesrajnsntOi, ? I! Fiberglas- Engine `ri-int Supply Di'/e. 10-41 Fee- Dr d# Saeto. II Fiberglas Engineering &. Supply Di'-'= 3.00 - i?th Si .,, SP=--' Dsn O'n Insule elen, 3500 - 20 th Ave,. Saerarrrr.t-e, tl Jackson & Hopkins 115 Cuk St., B-ck^j-sCsl^-s rj Western Assist oc Co. 675 Townsend St,,, SF-3 ^ ii Butter: AabRto-3 & Supply Co,, 532 iatcr&a St,,, SF-j si Atrr.streng Cork Co,, l3l4 Ogden D u Burlingsrce, M ,, 1 1 , Thorpe & Snn,, Ine,, 1351 Ocasn Ave, Emeryvixxe J p'nnt Asfceston Co,.., 1300 - 64tb Si-,, Emeryvili e, at Rc-taioiad Insulatio'n Co,, P 0, Bck 178, Terranee it C, Fe Braun & Ce,. 1000 So, Frerr.or.t Ave,, Alhambra it A / , ", X n su lat,:xt3g Product?,, g Argonaut Ins, Co, 550 California Sv ;ti Fluor Maintenance, J>.c, ^ Associated Indunnity Co,., " 332 Pine St.s SF--4 Stiii.e Cc.Tpensatiion Incurs, nee Fund, p e r so n a l Service; Ir h d S -tr isl IndSEsnity Co, 350 Sviscm e S t , SP-o A<-"-t}S' C a su a lty h S u r e ty Co,,, 20 Fiviitq oresry S t , SF=o " A ttn | R, E Airerican Motorists , T hiels Vuiwi,vCi.*? CVCV/:. (<S u p1~^t..'*.--,,7I| _***..-.--**(**-gorn-er. y j> >O--"* Pacific Employers Tr.?., Cc *, &44 Pine St, SK~4 Attn; S H, Hays Ae-ocelated Inderm.itj- Ccrg,* 332 line St.., SF-4 St eriur.rd Accident Ins, Cc , c.40' V0 Sail Brune Ave e, San Biuno Trays-lers Ins, Co, 550 Calii'cmias St, SF"4 Attn; Ciaxiss. Dapt, Argn/u.ut Insurance Co, 550 California St,, SF-4 & Brcphy 15^0 Ssn Pablo Ave, Oakland.-, Attn :To Richards on S-iCpy.'ick; Detert., Horan & Arnold 100 Bush St, SF-4 Attn; ^ Corco n Ksith , . ;i Li.-Livi- & Filipp!.. 315 Kcr.tgsalary St,,, _SF-4 Attn; fiubt, Mir-es I! ` 'hi-c-r? I;isur*nr.ce Coos 550 Kearny S t , t ST-b r..-j Mb.rnis m Ca-iunlty Indemnity E^chnnga, 55y Kearry St., s...f.~8 ,! v , m uh Ritienisi in., Ceai 5c 322 lV&annt:-taatt St,, SP-4 Attn; Don fiacri Hc-rsry F, 0 `Connell< % St.t*'i-.a-a CCccrrpp.. IInnisj,, .Fund 525 CHG, Ave J- Pat Gctdwin<. 41 Sutter Sc';., SF-iSb-hr Sr,F`--l"I jririgi Atira ^ Calif, Casuas li ttyy IInndd-'asrrm^niitty Eschang 550 Kenrry Si ,e o Sc,,Fr-8G ' Den Riicri ^ S-mitn Natio`nX\H 1 Xr,s, Co, _________ 9.j> SF-4 R, S, Boe.kfeitJith % GuaranXt*ee i3rrss , -Co, 550 Kenm y St ,, SF=8 Afi INTE OFFICE COMMUNICATION To J . E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Clifford P. Harding Industrial Accident State of California Claim 60 SF 193-85^ Commission (Afm st Api g CONTR 1961 Attached is a copy of a letter from State Compensation Insurance Fund to the Industiial Accident Commission of the State of California enclosing earning record from the Social Security Administration on the above subject man. DJM (2? ^ 5 l *1 ^ 3 FORM 1501 Printed In U.S.A. STATE COMPENSATION INSURANCE FUND rA T E AVENUE SAN FRANCISCO 1 EXECUTIVE O FFICES 5 2 5 GOLDEN GATE AVENUfc EARL R. HOWARD R. A. YOUNG H . C . M ILLER T. GRO EZIN G 6R i. H . L E IM B A C H . M GENERAL MANAGER A SST. G EN' L. MGR. COMPTROLLER CHIEF COUNSEL M EDICAL DIRECTOR LOS CH ICO eureka FRESNO LONG BEACH OAKLAND R E D O IN G ANGELES SA CRA M EN TO SAN BERN A RD IN O SAN DIEGO SAN JO SE STOCKTON VENTURA March 21* 1961 Industrial Accident Commission 3000 State Building 1111 Jackson Street Oakland 7, California IN R E P L Y R E F E R TO 340861 Clifford P. Harding Re: I.A.C. Claim No. 60 SP 193-854 Gentlemen: We are enclosing earnings record from the Department of Health* Education and Welfare, Social Security Administration* dated February 27* 1961. Copies of this earnings record have been mailed to the persons and addresses shown below. Very truly yours, HENBY F. 0*CONNELL Attorney - - HFOxfr Enc. c - Mr. Clifford P. Harding, 1407 Howe Ave., Sacramento 25, Calif. c - Smith, Parrish, Paduck & Clancy, Attorneys at 501 Financial Center Building, Oakland 12, California c - M R Camenter, Inc. 907 Front St., Sacramento 7, Calif. c - Fiberglass Engineer & Supply Div., 1041 Dr., Sacramento c - Fiberglass Engineer & Supply Div., 1200-17th.St., S.F. 7 c - Dan Caw Insulation, 3600-20th Ave., ^ $ r a ^ n t o , Cali. c - Jackson & Hopkins, 115 Oak St., Bakersfield,^alifo - c - Western Asbestos Co., 675 Townsend St., San Francisco c - Dutton Asbestos & Supnly, 532 Natoma St., San Francisco 3 c - Armstrong Cork Co., 114 Ogden Dr., Burlingame, Oalif. c - J T T h o m e & Son, Inc., 1351 Ocean Ave., E m e r y v i l l e , Ca l i f . c I Pllnt Asbestos Co^, 1300-64th St., Emeryville 8, California c - Metalclad Insulation Co.* P.0. Box 178, California c - C.F. Brun & Co., 1000 So. Fremont Ave., Alhambra, Caiiromia Industrial Accident Cccnisalon Rei I*AC# Cala Ko* 60 u? 193-834 PAS* 2 , ?&rc& 2 1 , 1 9 $ 1 e Coast Insulation products, c/o Argonaut Insurance Cerap&ny 350 California street, en Francisco 4, California c * Fluor Maintenance, Inc, c/o Associated Indossait7 wccpany 332 Pina itreet, an Francisco 4* california e - Industrial Indsesaity Co, 3$ Canacas it*, Can Francisco t c - Aetna Casualty & oursty Co, 220 Kcnigccsery et, u*F. e - American Motorista Ina* Ce-, 417 ilcnt^asery et, u*F 4 e ** Pacific iSsployers Ina* Co, 244 Pine ut, *^an Frsnc--sco 4 e - Associated Insssnity Corp., 332 Pina et, en Francisco 4 o * standard Accident h Ins* Co, 433 California et, uF 4 e * !*rsveler Insurance Co, 55C California et, ^can Francisco 4 e Argsnsut Insurance Co, 33 California et, oi Francisco 4 e - Hanna 4 Bropfcy, 100, Euch t, an Francisco^, California e edgslck, Detert, Moran. 4 Arnold, 100 Push et, >*P 4 - fcaOlen -ir Filippi, 315 Montgomery t, San Francisco 4 e - OvarsaKm.Xiuuxttaa* Co, 550 Kearny et, Dim Francisco 8 e - California Casualty XeOssnity Sxcasnge, 550 Kearny et, 8*F.t e lenith sstlcnsl Ina* Co*, 522 Market et., an Francisco 4 e - Claims Department - B u w g A t T o r O L & - A f i C .f-x_-""* ^ - 'K Ji^i ^^>~'-~S'd^U'-^&^*'1i%. kS^flVI,VOI4tSlNSItANCeoej^^r*tiJJ*b'^^^* v%-- . >,-. *^~ ,r*Kl ^*y%>*J>^ .""v*^*^* V';>5'-C":-^` > f' V'~^^^SS %Fe>ruary^27|^l^^ .^-fs^tPvAuYMFENNTr CCEFNMTTEERR-_r.... .^\\^-vr^-y*r^ii--ji--.j*`4?L:,'J*,` '. .i":.: -\~^*"*?\T 'Il.-'W-. ^_- UTIMORE2.MARYLAN -?-*- t;-. _*:/-*^f*. <rf -.- . r-%>-T;*b'* 3i-*r-~,-*';.>iv*^?**Wj>S-&'!- Estate' Compensation. Insurance Fur ,'4 `525 Golden Gate.Avenue .... -.,',..r -San-Francisco J.f~California ,y., M Refer*to:&3l*086l;; %tAttention:`Q Mr.H - J Veil ' '- ;- f,;IClaims Adjuster ,- ~G e n t l eTff*^ * 3- U^1-'- i'iT' ;. -T.', f'-.?,^"".T-.a^.,,'`it "V., " {[ "t *' " .. . ..'.*\ ' . r; K--.V. ; v -,-. -j -^-. Thlafrefera to1yourxTecent^letter,>abut|tie. social, security account-of.Mr.^Clifford P.tBarding. ' 1,'. , .+ /" -* i ;' *The^ollowing:informtio^4.sffurnished.as requested. j "... vt Employers -' - * 1 ` "Period'Ended : ^ Amount - . 'vT \ I-*-. 'f$225.0l*^-- [< Standard Sanitary Mfg.lCo. ^ ^6/30/37- '-4528.1*1*"-t. 'rf?p.i0. Box 1226 .';. :.-' j: ';i.12/3l/37_ ^ I; ^Pittsburgh;, Pa.- 1 . ' fiStandard Sanitary;Mfg4Co. -- 3/31/38 ` ,1 4>133.1*3'-.T r ) 6/3O/38 -.S `'^9/30/38`v filone t--/ -r.-./fii'*WftYUIP"* V.v >>. LC 1 2 /31/38'.-r; v i i l o n e - 'L ' '^Paradise Club .' * r* Ralph'L.^.Brovn,* Owner ' . '^3ox'lhl5 !-h, ft;. 'f Yuma,'Ariz./; j ,,'- '.J, sDenverTP l W i'Heating Co. lil8l0 Blaki St. f ' >.,Denver,-: Colo - _ 3/31/38. v ' 36/30/38' - '.^F 9/30/38 :\ ^ 12/31/38 1-5 X-'.J .-... - >,,. * ,'^v .* -1t3/3l/W ~-r -f6/30/UO r/ '*9/30/1*0 1 '\i2/3LfiO. , ij&ftao .`Q&s '.'jftRone %i[' - H o n e V&'y - ;::U35.0 ^ MlTonet;3 ( U `: ; ^ |H o n e ^ ; .-i'^ B o n e i.iy --., '^^29.1*0.'. Ralph Dines \`-*'; ,' r.3*'DBA. Dines;Supply,Co. 'S33^3'Walnut St. \v_, **^Denver A Colo.ni.ii." - 13/31/VO & . :U 6/30/1*0 t ?;*>9/30/1*0 '< <"^12 /31/1*0:r Hone.-./^. ` ^.Hone ,"`i11 `J Bone ' `' - li- T--TvjSj'enverjColo~:.~_ ^v .^% `^Ttie l l c e l y '-Corp.v ^ . ; 22 E^UOtb St. 3 'S e w lo r k 'C ity , *% ? ,, iWBiilip Carey Co. ^ - V ^ . ' `; 'V _ . ,, j. . v . ^ - --' r -..*>jr<- . , -r.v r* . . 1 iZ'qt;-* - ' - ' ^ C-" ' The phiit? carey " `r'" " (.^ l f o # ' # 3 `:^5S p | , ttcBh h h , ^ o .V j . - i - T* r rT1 -l ,'JotoMan^^ SalesCorp. V22 B-Uoth st. - _ ;., ; . ; . . H e w York'City 16,-H-* ^ - '43/3^^ ,..-6/30/^^ . 9/30A 1 -,, ." .,fiV7.75, v. .; ; .-/C! ^v;- . .c .V;. 2 t '.Star fciBert.tt '/;. ^6/30A2 -y.-^ '.Ki'^f^tODe ,*` ' 3^; Aeto-E^Chesti^^-y^.^^ i h>.: t.ni,iSvirLe;tKy* w-ts; &12/31/H2^ Dee R .' S h e f f ie ld 610 Jrtb.-St.jT*: St Petersburg, jone *v-> -v :*-V ,V->,:'U- '-! -l"';-*'?.-'-.'^v;v,?i ~ v ,, > - V ' f.- -. J. mmmg l^loneip^ ^pOone^i^,LW*T/iTa'9n i , ' .^^'lE^r'^' w**I. -V.a"*.*i.'*,..|i%Jiiro\n*e4&-"&/A.v*\^rt|Ssjan|eifPr k"^^%3/3l/51^: C4^i^MFdoVi.o^.BanforthiA re. '*r: 5 / J er s eyiCi t y i 3 * H iJ. /Jgd ^ ^ ^ 9/ 30/51 O'C i' ^32/31/p-^: '14tHone fs-,i. ^4 |Hone '^itp1 *02^r jfi'I^Hone --^>> tg.?st ?"--:*< ;,^>fe f ^ s ., ; '/.,-^W estern 'AsTaestos Co.; - :; v'; y/3i/5i . ; ' . --i'^ttO7f5jTa-oOWwoasaeenuduSsot..' ',,V- . ",, \,-- ,*^?6//3X0*/75c.1 7 ; V ? ^ a n ^ c i s c ^ c a i i i .r ": IODC = Hone - 020.56 vt^-y 2 * -an/tfi flngeieai.ggtr.uaLutvv ^wv.-1- , V ,. iT-^T"fr ,, 5fv-'-1<V^2/31/51N , i..'*'v*ti%r*L'*0*3.**i0%v;'Yt t :/.>/`'u.'-'1-...!'''*..rr.'..^...'rii--.- " .: --. < .* " - '--y:- 4+ L ' -.-Y',-^:-:-.-7lk'.l--.V'T-.'-''.-. \r-inVi-.." .l;r.n.'..*<.4--*-.'....4-,.''*..*... .:;".*,-Jr.Vivrr'.V*:,--.-.^-.=..'ST..4. ..5>..;: -,!.:..: ,TX;,->..'->-,'*)?_;i:. j J>r ' :-..;. -_. *i T " v - ' steam s'H oger8ilifg .t'C o.'' r V--,-. - *-* -------- M . i ' O '-V 3^': x & l 4 t tP e ; %:<%"* ''ly >;-"^ T >1nrit)nbastQS.Co. ;.vS?iSHorton st. -3 X'.-:? ^H ^ C? *f's?`^efe/3l/52 g ^ V , 6 /3 0 /5 2 ; < 3 -V ^ ;- Z - ; ; "S'jsl# '. iV- .... - t . ' iViA! i^:*/.^- ki"5f*:g/ , `iv 'r''**' c `*'"irr:'&,SiSTr"r1'-^>ai**!sr -" ---iS. *"sIrrr^rT!i.',-'3.V1i,,3-. j, * 1 3 ocean Ave. -w yfX '4^ 6/30/52 - * & : ? * ,;.:v#fEmexrfme^Califvr -t;f- 4 4 ,::# 9/30/52y;`-''v' '-: ^ * - * 12/31/52, -7 ** > ' f v Hone './ X Honeictlo. ' X Hone v '- Carpenter 7 :4 ,,,... ...... .* 907 Front S t / ` '- -- - Sacramento/ Calif. t" . 37.3/31/52 V-765.l647 r f 6/30/527|!p f : 7 ;7 ^ ^ i ^ l 3 0 2 . 8 J X : > 9 /^ /5 Z -'& nl2/3l/52- : -'...- J ' ; 4 5 8 . o o ; | s -? i7Rex Regnell -;: Z f j M Z L lander St. " 4 '-iHeno, Hev. _/ ,/ /;'x 4^63//135i //5522 /'1*'i`* ' ` -V\jJ-one t' # - y 9/ 30/ 52^ - '* "liiHoneX/Xi ;. ^. 1-2i/'3112/5/23;'1 / 542 .;--^,7 -.`' '.'.;j-HiokSn.ekO / i Fiberglas Engineering '4 3/31/52 - , - 7^6/30/52 ' '. r `'"*1 Hone "/ ''XV Hone . . 5 ':7 i ',?Hone : . Jt.i223.8o v: # ifRex RegneU '-: ;; :st4r .4 : . ' J ' i * 1 ' -. ' 'v.:Xi3/31/53 `. \ y 510.10.4 f19 /30/53 . _ 12/31/53 - - Hone , \ - - one , i;;Metal`ciad Insulation Co.,inc.,.\3/31/53'. /**-. - Box-178 - ...... .......4.;=6/30/53:;*-- .. i Torrance,'Calif. - *> - ..-,9/30/53 4 4 - 7 -12/31/53-.r ' V413.25 \4jl*67.fc0 : 7,-5>9,60..51501 ' - .X'?'v,-/-..r",R'.'iC..ar.pent.7e.r:.-,*X' x .7 ./ .4^Wester 4n-A8Kbe8to/ysy'CX o.^v,-.? -U4 - 675 Townsend St. *San Francisco. 3, Calif. ; * '7t3/3l/5^;> . >^30Mv . . ' .; y 9/30/5^ ** * J4M2/31M -r % j r' , r '-.-c ' ,,-,\3/3l/5ji- : . /; " ; v46/30Mr " r V9/30M - 12/31/5^ ' . /s Hone j, 'X 195.20 '^966.00 ri Hone - r, . .t'. W ; ? XHpne -* ' 3hl.fi)!i 4-Hone' .f Hone -0 :t . J. T. Thorpe & Son,:.Inc. 3/ M n 6/30M . i 9/30M ' , 112/31M ; . i Hone ,, 't Hone ` *> -i201.60 . -t327.60 T-J .JMs- i ' ;, _*.,,I-'-'-'- ' weBterniAsbestoff.,Co44". 3/31/56`.y a!'. V-1#Hc O . \,, rU :rM r mvy Am-. c^'^#: -{^3600 20th Ave. *4-. J;' - \ jf5kSacramento 20/;Calif." ft - i f 7 * T * rr*\,yfl r -'*Western"Asbestosr,Co. , - *} '^ ' ' i ,J" *- f* '-r Dan. Caw - . 7 \ ,*'Caw Insulations X i 9/30/56 .$12/31/56 .j J5 3/31/57 1 - i 6/30/57 u.9/30/57 . * 1 12/31/57 i , /3/31/5T ( 1 r6/30/57 1 i 9/30/57 i i 12/31/57 ` *1 -stratane^f * * *vi^ >iititl0K W \r . ^*i 'fc~vf p'- i-'0 *50:83* . >-% < ^XiB3.io, .* - -- rSHone * \ ' . , - ^ 1 s ,** .3-,., - `M - ; y " ` ., - 7 A , r " j'Hone i- \ ' --'.'C , i \ : 185.00 >*'-- , ' % '* % > , ' ' -IHone' r' < ,V v*\ f ^5,Hone t ^ T b e Jackson Hopkins,Co.,.Inc. ^ 3 / S . / 5 7 . ^-^Hone ,, v b . Q . - B o x ^90 r 'r.,.115 Oak St. f .' ^ 6/30/57 ..<1 *;U'48M.58* V ijio88.6o ;, -- & 9/30/57', *> , i-'.,'$1088.60 ' -'< - ;;yr:c .^Bakersfield/,Calif. 12/31/57 -, ViJLTO^Oj,' v i . . !< * , <., rV ,* - ":f> 'v, * ^* ''**;'il-i*^ insulation A Asbestos Industryf>23/31/57 /'i\ v -' ..Hone 1 - , \ i -*"" ^ Works of H.lCalif. ^ 6/30/57 ' / iv ; n 1^ Hone 3/31/58 w m 531.20;^ .6/30/58 1 ' TfHone;,^^^} ^ 9/30/58 ,,.,Hone' % 1 , - ^ -* A1 ` / ' C. F.KBrown & Co. * 4 ' 1000 S.s Fremont Ave. * * '`ijS.Alhambra/^Calif. I- <- - 12/31/58 ^ ^Honel,v.;'l*' p-i> ^ /.>* r ,1 *;* ^ 3/31/58 ' , - / ' UHone- '^S'*^T ?`66A/300//S588 % ' ' ' ' > - 956.65 *-* `' t 9/30/58 1 _ 7^ ai,u .~. - S T , . . , - .... ,'-itl2/3l/58 ^ '>ftii'i-i.-'" -V'41. *i'' *" > VL7fU^>v- .--7----.:'-:vi.^7 ;-.t_f:-.,i<->-AF.V,-?fc---/-v-f;-.'7.%.,-:-::J--S~;.ff-7Fy -;-y 1;-;"^^---:.: tiif.i 1 W-iit Jivu t-'1-_i_^ ^ -7,-\ &&&&&&;*$ ,,,,,,.Amount * A p. 0. Bax4153^ ? t ^Sacrnmento-Ti^Ca: -, ovens Caning' .'.P. o:-Bax 89 , , .`Sacramento,'1 Ct "; uJ^*:'.' -%1 o3V/^Svi2s .$.v-.<-i?i & * & % 516w.80v. ?a*-* 'xil Plant Astestos .'Co. 11300 *6lfth St. i 1 * ..BneryvlllR 8/ Calif. 6/30/58 9/30/58 12/31/58 ;, H t '-'v'i^Bone' ^ ^ _ '[<l *\- Hone '' 1 r. / ".M. R.'Carpenter ^ t; V ; , ; -,, ; - - >- . 3/31/59 *6/30/59 ,`.' '\dao8.io ? ;. ^ 1369.20 ^ ^ * ' .-.9/30/59 ' , . 'HHone- -, AJ2/31/59 V V 1' / 'Hone - .. r^A A -fe^v `t*' T * ~ f ''** ^.* 4 "**'ii - t *- f * f* i - '" * ' ^ O u r ineo(rds do not"shov.rthe amount of'eanlngs:ln each quarter ' W v 1. o flgsTlhecause .employers^irere requlxedlto.Xlle reports,only?twice i n .^ Ji-that y e a r .^ l ' 1 ' i ~rJ- ,,1** ', .* J- ,\ * ' .*- ,,* ,.<. j - V* ''*'! :' * 'fMriiHarding's'account* shows,no. earnings for,;1939 and .19^7*' > ^ ~\ . , * * v, . / $ Sincerely jours, _ . ` 1. i T ` |ijri < f A .*'Robert M.`Mayne ^ . ,, Chief, Payment-Center ij ,, , J V > 2* a 2 K i . ^"*1 a \.r vtjkr* Xv. '1 "V - - *1 ; ^ t- I2 -V-? 3t U M $4 M M 54 f 7 &.&> 4 l S 509.5 41. i ^i 5.41 f $ 4 J Ai S- ' `l ' 44 4f ,i \ s i n 4 /# 10 U, 2- O -- ,4 Ai ri ' i <v'?,H',)V& 4*1 + fe 5L%\ (*<\ b 8 JZ 4-1.%A 51 iV>), VI ( z64''^^ j`^vWX f > r \ 4<^ M a i *>'A\vC*lV a 1 1 j ,ii 5T \ I N 2 4*H1b 0 ^ r r>} ^ V x < I NT E R / office communication To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Clifford P. Harding Industrial Accident Commission State of California Case No. 6o SF 193-85^ (Arm strong CONTRACTING March l, 1 9 6 1 ^'K1-11 Attached to this communication is s notice of hearing before the Industrial Accident Commission of the State of California for actions by Clifford P. Harding. I note that this notice of time and place of further hearing was also served on Travelers Insurance Company. DJM \-\ . 5 i Tifvmcn f i l Li?*? FORM 1501 Printed In U.S.A. 4 Before the Industrial Accident Commission of the State of California vs. n* OWSirMSs&i* ****** ** *** A p p lica n t. Case N o 60 3? Notice of Time and Place of Further Hearing Defendant_ NOTICE TO ALL PARTIES You are hereby notified that further hearing will be held in the above-entitled action at " /.taw: li! 4539C &% fit 9 ' 0 3 Dated at: '"fclte&i, t& iJ fe s v * in d u st r ia l a c c id e n t com m ission NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED. SERVICE UPON: *** 2*5 ,,*?' J* _' n m s x & a X t m * r *** rjSKiSito uat'iswer - , ^ W .,-*** lf*tn T _ saw* ***., *T,,*,<* i v csfc ;VU# -*** *.*. ;i *V **%\ U'r J^i bl CC'S' at -VCv'w ?- Vv OV ** *i *4'(- 'Vy i W &T r"if a - - * - __ _* ; - ****-**" s- A i i a s s S i s s s a r- L-? V asr. at M O * * * . a "*%,*; 4*2a '>'rii rtiaias* ,, >**. V * Y y i U e A . . * * f t U l ! - -/--nr* *. *-* r - J p > * aV JtiwV* X . r w .}.<** % * _ . .. i-- ^ ^ " s s ^ . " i r . "4 r-ts-jn - . lit* * T o,,* JOO - &:**.' * - t r a -'itLirur^& t** **3*t2T COV 3i* ii 1 :'t* * _* F ^ l-S a iu r . o ; # S3 itentssei tL * f t s y - i a t e : '- Form t r u - c - u r s ~r in-1 !*--^*"V w fiv * # ~ v ? ~ . A -i :.x , ? iti.,* - - v 181t,*0-^40 -WM.*p'o-- STAGE T?O KOW-S ASt SISK SP ** Ci r W K S affili* c a a a a u > or * * S**" I* ^ J** st" "r * vgr i f , n r w i' ^ S T S t i o o s l te** " * $* rte1' -* r . HSSS ft t,iSS4 ^ i* triF&m* ' s w m m z c ^ , 5$0 saUi* X& t* January 24 1961 AIR HAIL Travelers Insurance Company 550 California Street San Francisco 4 California - Gentlemen! / Tour January 12 letter to AC&S's San Francisco Office regarding Clifford ,/ Harding has "been referred to the writer. His wages with corresponding hours worked are as follows* Week Ending Wages Hours 10-12-51 $ 38.78 15 10-19-51 103.40 40 10-26-51 62.04 24 12-5-54 12-12-54 12-19-54 12-26-54 201.60 32 126.00 s 40 226.80 40 126.00 ^ 40 1-2-55 1-9-55 226.80 56 126.00 40 In view of his limited employment with Armstrong Cork Company our cost under apportionment procedure in the case of an asbestosis claim would be negligible Standard Accident Insurance Company has already requested limited information regarding Clifford Harding. Very truly yours, R. C. Schiedt, Jr, Insurance Department MLT 1 <0 $ V, <X * > ;^ Vi O \ i:S` V * r( < <1 tj 5fc VX ^ V> * v9 to \!oc** % <a N<Si oQ <Oi OO Ti *\> > 1 lo o *0 * \a \3 >9v3 H . <\ fe) N % \ 'i <T *Y X 1 J._ Vi v> c ; N s 7( tt Ti Ti Ti N XX > 4- > V> *0 V, V) \ i <?* -N N. n t 1 n e\ N 'S. X N V) Vi V) i <x t -"N CLAIM DEPARTMENT A. C WELSH, C!olm Monogor 7 e / r ^ /r a m * &irawdm' January 12, 1961 BRANCH OFFICE 550 Californio Street SAN FRANCISCO 4, CALIFORNIA Telephone: DOoglas 2*3600 Armstrong Contracting Company 30A Shaw Road South San Francisco, California Re: B~ Armstrong Contracting Company Clifford Harding - Injured D/A ? Gentlemen: . The question I am about to ask you will probably involve getting records of this man's employment from your Eastern office. We have an Application filed before the Industrial Accident Commission by Mr. Harding allegihg over the years he has contracted asbestosis and is seeking compensation benefits therefor. I do not have the exact dates of employment, but it will undoubtedly in volve the previous carrier, The Standard Accident Insurance Company also. To the best of our ability to learn, he was employed by you during 1953, 5A, and 55, and his present address is 14-07 Howe Avenue, Sacramento 5. We do not have his social security number, but his date of birth is given as February 28th, 1896. Would you kindly set in motion the machin^gj^to secure for us the exact dat&jof his working for you and his exact weekly earnings, so that we will know what policy year to charge this loss to. I am sending this letter to you in duplicate in the event you wish to refer it to the Standard Accident Insurance Company. Thank you. Very truly yours, AJSickr Enel. A. J. Schaefer Supervising Adjuster HOME OFFICE! 700 MAIN STREET, HARTFORD 15, CONNECTICUT EMPLOYER'S REPORT OF INDUSTRIAL INJURY STATE OF CALIFORNIA B"9527634 DEPARTMENT OF IN D USTR IA L RELATIONS D IVISIO N OF LABOR STATISTICS AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. - Every question must be answered fully to avoid further correspond ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code. Section* 6407-641J) P1..S. Mk. .hi, ..port 1. DUPLICATE Every work ,,jury to .n oroployrcwEch .h* EMPLOYER (Give name under which 1 . Name concern does business) . (No. and 2. Office address S(Mtreaentu).facturing shoes, retailing men's 3. N ature of business clothes, trucking for hire, e c.) ....... tta;. ... rw d t. to d..th, ..p o rt m ">U ? t.l.p h o n . o . t o lo p .p l dnoctl, --------------- DO NOT WRITE IN THIS COLUMN (City or -.T ow n)-- Case No. Employer No. INJURED e m p l o y e e -Soc. Sec. No.. 4. N am e. (No. and 5. Address Street) -- 6. Age.. 7. Sex; Check (V ) 9. Number of hours worked per day- 10. Wwaages: .... . ------..-per hour, or $-- Male F em ale. per week- -p er day, or t . .SSCL 8. Check (vO M arried- Single- Number of days worked per week-- -- -- -- -- -- ------ ___________--per week. , . (If earnings at irregular rate, such . ,, piece work or on commission basis. enter actual average weekly earning, for convenient period not to exceed one year.) n . If board, lodging, or other advantage, furnished in addition to wages, give eatimated value t ---------- --per week Industry Age Sex and Marital Status a c c id e n t 12. Place of accident (No. and --Street).. of 13. On employer's premises No)------ 15. Date of accident- (Yes or accident? No).. 18. this day? (NYoe)s o-r-- 20. 14. D epartm ent16. Hour of d ay - -A.M./P.M. If yes. give date last workedIf injured in a mine, check ( Y) accident location: Surface- _(County)_ 17. Did Injury result In disability beyond day of ________ ________ ip. Was injured paid In full for _____ Mill _Underground________ Shaft-------- CAUSE OF ACCIDENT 21. Occupation (job title)-- occuD ation? Check (vO L ess th a n 6 m o n th s -------- ------i 6 m o n th s to 2 y e a rs -- (Describe briefly, such as: loading ^truck. operaring^ occurred? drill press, shoveling dirt, walking down stairs, etc.)------------------ ___________________ _ 22. How long employed by you a t this over 2 years______ 23. W hat waa employee doing when accident ------------------ ------------------------ /describe fully, stating whether the injured person fell, was struck, etc.; give all 24. How did the accident happen? S 'o m conSbut'ing to* accident. Use other ride of report for additional space) Weekly Wage County Aeddent Date Occupation Accident Type Agency _____ ___ ---------------- ---------------- -- ---------------- ' (Name the specific machine, tool, appliance, s. W hat machine, tool, substance, or object was most closely connected with the accident? gas, liquid, etc.. Involved) _ ------------- ---------------- -- (State if gears, pulley. 26. If mechanical apparatus or vehicle, what part of It? {y " 0rj etc-) ------------------------------------- ' ~ " (Ye. or 27. Were mechanical guards, or other safeguards provided? No) -- (State the spIfirpreventi*m easures th at can he taken by employer and workers. 29. W hat do you recommend for preventing this type of accident? >o not say, " By being more careful." Specify what should or should not be done) Agency Part Mech. Defect Unsafe Act nattuf OF in t u r y a n d p a r t ok b o d y a f f e c t e d Personal Defect 31. Name and address of physician.-. 32. Name and address of hospital---- (Yes or 33. Has employee returned to work? No)...... - (Yes or 36. Did injury result in death? No)------------ 34. If yes. give date~ 37. If yes. give d a te - 38. In case of death, give name and address of nearest relative.-- --------- 35. At what wage? 5 - Nature of Injury Location Extent of Injury 39. Names and addresses of witnesses.--------- Insurance Carrier 40. Is injured related to Employer?.. Signed by- C -4587 R e v. 7-5J p r i n t c o i If so how?_ Date of this report- Signature -Official position.- Filing of this report is not an admission of liabUity. ". . , No report of injury required to be filed by an employer or an insurer by this chapter shall be admissible as evidence in any adversary p ceeding before the Industrial Accident Commission. Labor Code, Section 64U. Report Lag Coded by EMPLOYER'S REPORT OF INDUSTRIAL INJUR \i STATE OF CALIFORNIA B-9527634 DEPARTMENT o f in d u s t r ia l r e l a t io n s D IV IS IO N o f LABOR STATISTICS AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY - 1956 Webster Street, Oakland 12, Calif. { ' Every question must be answered fully to avoid further correspond ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code. Section 6407-6413) P l.,, . mike this rspsrt I. DUPLICATE that w ... - ' , 1 , Every work injury to an employee which the taj5r"w5ulU ta death, a report must be made by telephone or telegraph directly sirs -- em plo y er (Give name under which 1 Name concent does business) (No. and 2. Office address SS(Mttrreaeenteu).tf.a) c-_t_u_r_in__g__s_h_o_e_s_,__r_e_ta-il-i_n_g_ m__e_n_;s-- y M einr n( hnatne-- clo th es, tru ckin g for hire, etc.) . s (City or ..Town)-- --------------------- --DO--NO-T-W-H=ITE IN TH IS COLUMN Casa No. Employer No. injtjked EMPLOYEE __Soc. Sec. No.. 4. Nam e.. 5. Address 6. Age. (No. and S treet)...... 7. Sex: Check (V7 9. Number of hours worked per day- 10. Wages: S------- ..per hour, or 8- M aleper week- Female -.per day, or 8- and 8. Check (V ) Married- Single Number of days worked per week--------------------------- -- ____________ per week. (If earnings a t Irregular rate, such ,, p ie c e wmk or on commission basis. enter actual average weekly earning, for convenient period not to exceed one year.) 1 1 , If board, lodging, or other advantage, furnished in addition to wage,, give estimated value t .... - P * or * . _per week Industry Age Sex and Marital Statue ACCIDENT 12. Place of accident S--t-r--e"e(tY)--esor 13. On employer', premise. No)------ IS. Date of accident accident? (NYoes) or 18. (Ye, or 20. this day? No) .... (City or --Town)__ 14. Departm ent16. Hour of day- --A.M ./P.M . If yes. give date last worked----------- -- ------------------- -- If Injured In a mine, check ( V) accident location: Surface- -(County)- 17. Did Injury result In disability beyond day of ________________ 19. Was injured paid in full for ______Mill_____ Underground------------Shaft------- CAUSE OF ACCIDENT 21. OOccupatio n u(jooob utitulec); ---------------------------------------------------n a t i o n n?? CC necx ^( v ) ^L.esanuianv '`^`V 1"------- ------- l- y t s (Describe briefly, such as: loading truck, operating occurred? drill press, shoveling dirt, walking down stairs, etc.). r . -------------o v e r2 y e a r ^ 22. How long employed by you at this . , , . ., , 23. W hat was empioyee doing when accident -------------------------------------------- fully, stating whether the injured person fell, was struck, etc.; P v eall 24. How did the accident happen? factor, contributing to accident. Use other side of report for additional space) -- Weekly Wage County Accident Date Occupation Accident Type Agency __________--' ---- """ (Name the specific machine, tool, appliance 25. W hat machine,. tool, substance, or object was most closely connected with the accident? gas. liquid, etc., involved) _ -------------------------------------- - (State if gears, pulley, 26. If mechanical apparatus or vehicle, what part ot it? etc' ) ' * (Yes or 28. W at injured using them? No) 27. Were mechanical guards, or other safeguards provided? No) -- fstateT hesoed^prevTO tivV m surM th at can be taken by employer and workers. 29. W hat do you recommend for preventing this type of accident? >o not say. "By being more careful." Specify what should or should not be done) Agency Part Mech. Defect Unsafe Act n a t u r e o f in ju ry and pa r t o f body a ffected 3 1. Name and address of physician------------- 32 Name and address of hospital.---- (Yes < 33. Has employee returned to w o rk ^ ^ No).. 38. Did injury result in death? No).... - .... __ 34. If yes, give date.. 37. If yes, give date.------- 38. In case of death, give name and address of nearest relative.- ex-ample: amputation hand, etc.) ------ -- 35. At what wage? 8- Personal Defect Nature of Injury Location Extent of Injury 39. Names and addresses of witnesses.- Insurance Carrier 40. Is injured related to Employer?.. Signed by-- If so how?- Date of this reportL. Signature _____ Official position Filing of this report is not an admission of liability. . , No report of injury required to be filed by an employer or an insurer by this chapter shall be admissible ^evidence m any adversary pro ceedine before the Industrial Accident Commission. Labor Code, Section 6413. Report Lag Coded by w, ,, , msk, TO STATE OF CALIFORNIA d epa r tm en t o f in d u str ia l r ela tio n s DIVISION OF LABOR STATISTICS AND RESEARCH Claim Departm ent THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. ,,port In DUPLICATE that . . . < * "ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code, Section* 6407-6413) B-9527634 U - ... EMPLOYER _ (Give name under which 1. Name concern does business) _ (No..and 2. Office address S(Mtreaent)ufacturing shoes, retailing men's 3. of husiness clothes, trucking for hire, etc.) ..... . (City or ..Tow n)-- INJURED EMPLOYEE 1 Name-- 5. Address 6. Age (No. and Street) 7. Sex: Check (vO 9. N um ber of hours worked per day-- 10. Wages: X--------------------------------..-p-e-r---h-o--u-r-, or $ as p ie work or on commission basis, enter actual Male F em ale. per week- _per day, or t . (City and - Sttaattee). __ Soc* Sec. No*. 8. Check ( vO M arried. Number of day* worked per week ____________.per week. (If earning average weekly earning, for convenient period not to exceed one year.) n . If board, lodging, or other advantages furnished in addition to wages, give estimated value t --------------------- P d * y , o '_ t _ Single. at Irregular rate, ..per uch week DO NOT WRITS IN THIS COLUMN Casa No* Employer No. Industry Age Sex and Marital Statue a c c id e n t 12. Place of accident (No. and Stireet).. (Yes or 13. On employer* premise No)---- IS. Date of accident- (Yea or accident? No).. 18. [Yes or 20. ! 14. D epartm ent. 16. Hour of d ay . _A.M./P.M. If yea, give date last worked. If Injured in_a mine, check (V ) accident location: Surface. .(C o u n ty ). 17. Did Injury result In disability beyond day of ____________ lo. Was Injured paid in full for Milt___ Underground------------ Shaft-------- CAUSE OF ACCIDENT 21. Occupation (job title) occuoation? Check (vO Less than 6 months------ --- ; 6 months to 2 years. (Describe briefly, such as: loading truck, operating occurred? drill press, shoveling dirt, walking down stairs, etc.)----------------- over 2 years. _____ 22. How long employed by you a t this 23. W hat was employee doing when accident ----------------------- ---- -------------- (Describe fully, stating whether the injured personJeU, was struck, etc.; give all 24. How did the accident happen? factors contributing to accident. Use other side of report for additional space) Weekly Wage County Accident Date Occupation Accident Type Agency .. . ------ 1 ' ~ ~ (Name the specific machine, tool, appliance, 25. W hat machine, tool, substance, or object was most closely connected with the accident? gas, liquid, etc.. Involved) - --------------------------- ' ` (State if gears, pulley. 26. If mechanical apparatus or vehicle, what part of it? etc-> * ........ ...... (Yea or 27. Were mechanical guards, or other safeguards provided? No) 29. W hat do you recommend for preventing this type of accident? ____________ .___ 28. Ww aas injured using thnemnu? iNnoo); ---- ----------------- ------(State the specific preventive measures th at can be taken by employer and worker. Do not say. " By being more careful." Specify what should or should not be done) Agency Part Mech. Defect Unsafe Act MATTTUii n r TNTTTRY AND PART OF BODY AFFECTED N A T U R E ^O FJN JU RY of the ,njury ( the body affccted. 0? | J f ^ e:etai n),,uUtIon 30. of right index finger a t second joint, fracture of ribs, lead poisoning, derm atitis of left hand, e t c .) ---------- 31. Name and address of physician- 32. Name and address of hospital. (Yes or 33. Has employee returned to work? * No)---- (Yes or 36. Did injury result in death? No)------------ 34. If yes. give date37. If yes. give date.. 38. In case of death, give name and address of nearest relative.-- 35. At what wage? X- -per- Personal Defect Nature of Injury Location Extent of Injury 39. Names and addresses of witnesses-- Insurance Carrier 40. Is injured related to Employer?signed by.. C-4587 Rev. 7-53 prihtco im u.s . a. If so how?_ Date of this report- Signature -Official position-- Filing of this report is not an admission of liability. " . . . No report of injury required to be filed by an employer or an insurer by this chapter shall be admissible as evidence in any adversary pro ceeding before the Industrial Accident Commission." Labor Code, Section 0416. Report Lag Coded by EMPLOYER'S REPORT OF INDUSTRIAL INJURY STATE OF CALIFORNIA nFPARTMENT OF IN D USTRIAL RELATIONS D IVISIO N OF l a b o r STATISTICS AND RESEARCH Claim Departm ent THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. Every question mu6t be answered fully to avoid further correspond ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code. Section 6407-6413) B-9527634 Please make this report in D U P LIC A T E so that we can file than first Eve" work injury to an employee which ^ ^ y U th l r n ji^ results ki death, a report must be made by telephone or telegraph direc y 5 ^ ; ^ EMPLOYER (Give name under which 1 . Name concern do business) (No. and 2. Office address S(tMreaent)ufacturing shoes, retailing men's 3. nf husiness clothes, trucking for hire, etc.) - --------- :--------------- --DO N-OT -WRfITSt IN THIS COLUMN (City or .Town)-- Case No. Employer No. in jured em plo y ee 4. Name.-- (No. and 5. Address Street) -- 6. Age.----- 7. Sex: Check ( V) 9. N u m b e r of h o u rs w o rk ed p er d a y . _.per hour, or M ale.. per week Female. , _per day, or 8 (City and _ State) - 8. Check -.Soc. Sec. No.. ( vO Married- Single- Number of days worked per week - ____________ per week. (If earnings a t irregular rate, such xo` l or on - o . z z z l * -- -un*- ^ ^ not to ^ z z t * U . If board, iodging. or other advantages furnished in addition to wages, give estimated value S-- --------------- ^ ^ 1 per week Industry Age Sex and Marital Status ACCIDENT 12. Place of accident (No. and St!reet).. (Yes or 13. On employer's premises No)------ IS. Date of accident (Yes or accident? n " . ' _________ ^ (Yes or 20. this day? Noc) or Town) ^(County)- 14. Department----------___ 16. Hour of day- _a.m ./p.m. 17. Did injury result In disability beyond day of ______________ _ 19. Was Injured paid In full for datS W rlCed" _____ Min ..........Underground------------Shaft-- -- If injured in a mine, check (V ) accident location: Surface CAUSE OF ACCIDENT _______________________ 22. How long employed by you a t this 21. Occupation (job title) occupationn???(DeCCCschhhreeeicccbkkke (((bvvrOiV')eflLLMye,-esssslustctohnhaanaanso6:dinmliooomannd.tiuhgnsg----tt-rr-uu--cc----kk---,,--oo-.**pp. ee6"rraam--tt-iio-nn-n-gg-t-hs to 2 yearaoccurred? drill press, shoveling d:rt, walking down stairs, etc.). i over 2 years______ 23. W hat was employee doing when accident Weekly Wage County Accident Date Occupation Accident Type _____________________________------ -------------------------- ------- ~ (Name the specific machine, tool, appliance, 25. What machine, too., substance, or obiect was m o closely connect, with the accident? gas. llouid. e tc. invoived,_______ - -------------------------------------- ' (State if gears, pulley^ 26. If mechanical apparatus or vehicle, what part of it? motor, etc.) " * * * ...... . (Yes or 27. Were mechanical guards, or other safeguards provided? No) 29. W hat do you recommend for preventing this type of accident? ___ _____ 28. Was injured using (thneema?r nNoo); ---- ---------- r m L ' " (State the specific preventive measures that can be taken by employer n<i workers. & not say. By bring more careful." Specify what should or should not be done) Agency Agency Part Meeh. Defect Unsafe Act NATURE OF INJURY AND 0^ ^ j ti ^ a S <th e ^ p a rto m e :^ y >affected For eximple: amputation , (Describe tn detail the naSturSe oif itnhe fra>cJturVe o7 riSib.i.M' le^add pDooiissoonniinngg.; ddeerrmmaattiittiis, ,of left hand, e t c .) ----------30. 31. Name and address of physician.------ -- 32. Name and address of hospital-------^--.--33. Has employee returned to w o rk ^ ^ ..... 36. Did injury result in death? No)------------ __ 34. If yes. give date37. If yes. give date.------- 38. In case of death, give name and address of nearest relative. 33. At what wage? %--------------------- per.. Personal Defect Nature of Injury Location Extent of Injury Insurance Carrier 40. Is Injured related to Employer?. Signed by Signature Date of this report, Official position Report Lag Coded by C-4587 R ev. 7-S3 p r in t e d in u .s a. ceeding before the Industrial Accident Commission. Labor Code. Section 6413. HOME OFFICE AT HARTFORD, CONNECTICUT the travelers insurance company THE TRAVELERS INDEMNITY COMPANY THE TRAVELERS FIRE INSURANCE COMPANY W e are in receipt of advices of an injury to the person named below. If this injury was the result of an accident which occurred while this person was working for you, please furnish us with full report It is necessary that you make this report in duplicate so that we can file copy with the administrative authorities in your behalf as required by law. Your cooperation in promptly completing and returning these reports will be appreciated. DATE , 1 -1 1 -6 1 RE Clifford P, Harding d/a 1-1-56 B-9527634 r "1 Armstrong Cork Co. 304 Shaw Rd. L J S. San Francisco, Calif. C -!6 5 9 REV. 3-52 printed in u.s .a. Address all replies to: Claim Department, The Travelers T?56 Webster Street, Oakland 12, Calif. / '/C 'Jraik HOME OFFICE AT HARTFORD, CONNECTICUT f t is s ... m m m .... W e are in receipt of advices of an injury to the person named b e l o . Y administrative authorities in your behalf as requ,red by ' t x ' j r j z z r P^ t = : on the attached forms as required by the Compensation law. DATE , 1- 11-61 RE Clifford P. Harding E,t j z z z t * " "d "" 9 ,h" ' P ------------------ --- -------------------------- B-9527634 r Armstrong Cork Co. n Lancaster, Pennsylvania Addrett all replit to: Claim Department, The Travelers C-1659 REV. 3-52 printed in u.s .a. / January 13# 1961 Standard Accident Insurance Company a;,n Vest San Bruno Arenue San Bruno, California Genti ement Attentioni Vera E. Dowling Replying to your I m u e i y 10th letter, Clifford R, Herding e enployei by Armstrong Cork Company during the following periods in Californi | October 11, 1951 to October 2U, 1951 Horember 30, 195A to January 9, 1955 Veiy truly yours, E. C. Schiedt, Jr. Insurance Department MLT izo L K KIRK P r.n d .n t 5 1 ! Standard Accident Insurance Company m e O D f O M T t O ` * CASUALTY FIRE MARINE FIDELITY SURETY R O Y W. SM ITH Ma n a g e r N o r t h e r n C a l if o r n ia b r a n c h O f f ic e 840 W EST SAN B R U N O AVENUE San Bruno, Ca l if. January 10, 19^1 PHONE JUNO 3-4000 AIR MAIL Armstrong Cork Company Lancaster, Pennsylvania Re: S-309^ Clifford P. Harding vs ARMSTRONG CORK CO. Attn: R. C. Schiedt, Jr. Insurance Dept. h a 1/ 3 Gentlemen: WE WILL APPRECIATE IT IF YOU WILL CHECK YOUR PAST EMPLOYMENT RECORDS AND ADVISE IF CLIFFORD P. HARDING WAS ON YOUR PAYROLL DURING THE PERIOD 1950-55* WE HAVE BEEN PRESENTED WITH ANOTHER A3BEST0SIS CLAIM AND THIS PARTY ALLEGES HE WORKED F88 YOUR COMPANY DURING THIS PERI00. YOUR IMMEDIATE ATTENTION TO THIS MATTER WILL BE AP^REC,^ i inasmuch as this case has already been presented to the industrial Accident Commission and is due to be set up for a hearing shortly. Very truly yours, VED/ms ENV ENCL VERA E. DOWLING Claim Representative v ^r\ I - U ' s \ \ f-S'V \ c -U r'S I 1 ) -)rh $ & t" P lanet Insurance Company. Detroit Standard Accident Insurance Company, D etroit P ilot Insurancs Company. Toronto ///TER t / j office/ c o m m u n i c a t i o n To J. E. Zeller, Lancaster From A, L. Stokely, San Francisco Subject Clifford Harding - Asbestos Worker Asbestosis Claim (A rm strong CONTRACTING January 16, 1961 Attached are two copies of the Travelers ' "W ' 8 letter nf January 12th informing us of an application before the Industrial Accident Commission by Clifford Harding, claiming Asbestosis and seeking compensation. Our records do not go back to the years indicated. We have no, memory of a Clifford Harding working for us. . Let j understand that these claims are properly handled by referring \ L^fthem to you. ^ We have been unable to determine from John Murphy s old records that Clifford Paul Harding of 11*07 Howe Avenu fc California, whose Social Security Number was 564-50-2264, quit our employ*on Jamary 7, 1955 when sent to work in the Shipyard. DJM Form 33377 6-59 i Jam m y 12, 1961 '< Armstrong Contr-.ctlng Company _ , 304 Shaw Road l South San Francisco, California Re t B- . .- Araatrcng Contrr cting Company Clifford Harding - Injured D/A ? , Gentlemen* ' v^ " . . The question I am about to ask you will probably involve getting records of this man*a employment from your Eastern office We ha. a an Application filed before the Industrial Aocident Commission by Mr. Harding alleging over the years he has contracted asbeatosls and in soaking compensation benefits therefor I do not have the exact dates of employment, but it will undoubtedly in volve the previous carrier, The Standard Accident Insurance Company alee* To the best of our ability to learn, he was employed by you during 1953 54, and 55, and his prosont address is 1407 Howe Avenue, Sacramento 5 M ' . Me do not have his social security number, but his date of birth is given as February 28th, 1896 Would you kindly set in motion the m a c h l M g y to secure for us the exact dstesof his working far you and his ex*'ox weekly earnings, so that we will know what policy year to charge this loss to* . . ' ? I am sending this letter to you in duplicate in the event you wish to refer it to the Standard Accident Insurance Company Thank you