Document LMy0g4NqYRNBD4OZJNGq8Jv3

FILE NAME: Insulators Workers' Comp Claims (IWC) DATE: 1963 DOC#: IWC011 DOCUMENT DESCRIPTION: Claimant - Novak, Edward >-, - 1 ' .2 6 1 -0 2 1 6 . Cable Ad d r e ss Alexcand1 Teletype 4 1 2 - 6 4 2 - 2 102 " ALEXANDER AGENCY, 'INC; /' INSURANCE-WORLD WIDE SINCE 1353;.- ' A - . 3 1 6 F O ' U R T R a v e n u e / - P I T T S B U R G ^ , P A . , 1. 5 2 2 2 ' - O c to b e r '2 0 , 1964 '' (T uesday) \-. T " R e lia n c e ' Insurance .Company;;./ / p , ; - s . ^ /;./ ' -A.. 545 S.,. Kings le y Driv f / < ;u/-s :/-/ Los Angeles,- C a lif ornia 9005/ y y t-. V-; j A tt n tio n s . Mr, KcDonaldy-. _ r\ ?/.;/- ';*;/v /A j , / , , Re:: Claim No, 91-C-436249 ' ;`/'L Armstrong Cork Company m-// . y//^. Gentlemens >{ f / '/-/T h a n k you fo r your.`l e t t e r 'o f t h e /19 th con cern in g' the a b o v e. Y o u r / , l e t t e r . o f tbe 9 tirw oubt ~have'In r n' n n 1.1' I `|f J"C ^ l-~-n in 1 ^ " / _ O<M Ifce Armstrong C ohtract in g 'a n d Supp/y Company was.-brought in to ; EWexisten ce" x>n January,' 1 , 1958, . i t v a s / f oim ed'out'.of ..tlie'V C ontractin ' 'D iv is io n of the Insured, th e A'rmstrong Cork Company.'.. A c c o r d in g ^ ^ inform ation'' rec e iv ed f r bra;th e A rm strong's Home O f f ic e . Mr. Nova^-t/ - / / / was employed from 1940 t o , 1952. / - W / .'v -r.;-- *-- J ' ' " ' / y ' ' * _ A.-ri rlpnf Tnfinranee company' had/no coverage f or; th e / Armstrong; C o n tra ctin g and Supply Company... :;/ ';//p lu n k in g ,you fo r .your e f f b r t s in ..t h is m atter, I am,.' \ :..y V/ / V / ' / - .` ;: y / v / / . , ; . / / - - / .-Very, tr u ly y o u rs, ; RR5 :eh / / `B ev erly R.- Shriyer- GUR SECOND CENTURY OF INSURANCE SERVICE er* '\ ' .V' ^ r. v -<s':-, Vc'.,.'-'ivi saitoctot* ymofilin) tc i*j*w tati J'*?/***,-"**!*iaL* 7. ..- Thii - V appGcjtloa . r r >. u -: filed'to dctemiqe ,, - ^ _ -..V , luTbi--i-l-i*iyYf-qn..; V :' ^ Y : Y ^ '-V-'/'- '> . r'** Y-.v-- ;v *v .r\^.''v '*^y ~ Va.'`L'\<i t ^ f r ^ t i s 2 : m $ m c.. ^ '* ` "~-:..Y'.' >- , , -* THO ^frr un - - I -itjv '''- -. - * , i - t . A- .*-*/ . .1 ', *; . . -*"'-CV .' i_ 'm / " ,' ? ^ iq i o- . ~ v ^ , __ . - 2 V i , -- V V " C r ^ T -, ' r - *-* -.-. ..' M I W U ' Vs ? V I 3 3 1 - ;L_- ; * .':- V.*Y V Y * ^ f c f f =._' ,, ' T" , *'- ; *K; -V - ' ; lJ- ? ' s S ^?- * 3 j **.*- ,,*-* 3 1 * * -V ' - ' 3 . ,-- - '' _3 * ; '' r ~ v t '' * %- : - ' - v- , r> .. VYYy ^ Y '- t -f *-*-S*A T Otti* '- o' -r*' ~*"t 'K,'' M' ,.' *` f'|| '* '*. . 't*. y*t >>11N0.- /U.'*- -j*,'-'*' -tf.' .4'"* < >r- * V-** -* *`C**^ * "*x - - - *V ' ^ -' il /ft' '`-t '} *i*t**\ ,i,'M .v<.V ' , ru, I f. ' ' - , , >o .. ***...' - <* *` ' ' , .t - c - - -* n r - *>. V ^ V - "V - : TV.:j :>. V . ;'-:?Si ' `7 _ ,* _ ^ '-T" : ': -V *--- > - - >r*.,''; - V -' T* ' ^ * ~=* ^ ! r ~^ \, r - ',>* _' . 'i-"-' -"y ns'tv j" ' ^ i , s - , . j. . - - ' ,, = -A ' *-\'%, *v 'i. "1*''^*"' " _ "* * J >- ~^^-T -',`T*?'.' ^ ` v -\c ' t ,-l . ; Before the Industrial A ccident Commission . ***7 ;: of the State of California ' i - V SDH A 93 OVaK Case N o. - 2^0 8^ . /.. ,, : -.AC' : -j Applicant - y -: -5 v. '. -, y Vvv* 8 - "f -h P \T ~ .;` 5 S y - vAYi .' TQ.?k i h s c l a e i o t c o h p m y v sr.% attached-Lin o n i! Aim Order Joining Party. ".'i-*:* 'F'* /. .-. i- ' " ` " ->-,0.- - D efen d a n t* -j- \ y- THE A^miA CASUALS Aim SURETY CHPABY;' 'FrT . V;f COr'POMATI Off} PACIFIC EMPLOYEES rJSURA'SCFTi "I'-. COIiPAHY, A COFPOFAIIQT} PIRHA5 *S MJKDl- V: WinVxSU WPAiTY, ' COKPOfiAPIOIi > Defendants . - . Good Cause Appearing Therefor: IT IS HEREBY ORDERED THATp /;f ; ;OFF..''K;\;i u^VV;'Y: ' m i Airnu casualty a t d -knlsrY cohpsy,-a coapokHIoh, PACIFIC EH?L0Y3HS i 3D?UB0S" C.OKPjt'Y, A COR?i>Ra?IOIf, F P 'F L U H S I-'UIiD. I T S F B a H u E C O M P A N Y , - C 9 A P Q 2 A ? 103 be joined as a party defendant in die above-entitled cause. Auguste 29, I 98I4. - - A. ; , . ' . - ; . P a r t i e s sc?rv e d i 5/ 20/ 6L . . Edward Iiovak> 3855 H iverton . Avo*, n o r th H ollyw ood . A ' / Fi l H a st Y. Huy s , 6 33I. H o lly w o o d B lv d .,-L A ----- WI--PlAr-- Phorpo I n s u la t io n . C o ., 271}1 S , Y a t e s , LA . E ar in o E n g in e e r in g C o. ak a F i b e r g l a s s l!n^ Industria^ accident commission - ; 5933 T a ir g r a p h H e!.,-L A 90022 ' , ; R asce I n s u l a t i o n .C o ., U563 V a lle y S l v d . , LA 90032 _ ' . _ P la n t I n s u l a t i o n C o ., 2?1}1 Ytxfces A y e ., LA. 90022-a k a . lho:rpe I n s u l a t i o n C J a c k so n H opkin3 C o ., Pox ]}99, B a k e r s f ie ld . . ' A rm strong Cork C o ., 5037 P a t a ta S t .., S o u th C a te . - ' A t t i R on ald S . v i l i 3on A m a tr o n g C o n tr a c tin g k S u p p ly C o ., E3E0 D i s t r i c t -31vd* , LA 93158 P la n t A s b e s t o s C o ., 15!;0 \ i. 9t h , Long Reach '' ' - F a r in a F n H n u e r ln g C o ., 11+301 n 3v /o rth , C ardona . - P a c i f i c F n p lo y a r 3 I n s .. C o ., l}05'3 O i l s h l r e B l v d ., LA 90005 . F lr e n a n 's Fund Ina* C o ., Box 2323 LA 90051}- A t t i 1?. ? . Shoop ( 2ca) The A etna C as. c S u r e ty C o ., 2)4Oh. u i l n h i r o J l v d . , LA 9005h .- ". toin gaud , K endig k S t o c k w e l l , 611 S , C a t a l i im , LA 90035- . . ` z-C opj o f . a p p l i c a t i o n s e r v e d 5/ I O / 63* rc\*M 3 4 6 INDUSTRIAL ACCIDENT COMMISSION ' STATE OF CALIFORNIA EDWARD JJOVAK N otice o f H earing ' ' Applicant_ _ _ vs. THORPE C O K ? AiYM ET AL .Av . SIS ATTCIC?D':tx!PHR A B D .. THE AETu A C A S U A L T Y A HD SURREY CTEPA:iTr A - ' ` - CORPORATIONJ P A C I F I C SMPLO'/EHS 'HSt/EASCE.- W COM? A 'IT, A -C O R P O R A T I O N I PIRITIA fS'FTHI> ;. I STTRAMCS COiPAfY, A 0 R P O U I 0 5 .'7' .. " '. \ ' ; . 1 : W . A - v - ' - Defendant Case N o .:. 3 te .-2 0 .$ 5 k *S*L * ' . ** Y ou are hereby n o tifie d T h a t an application fo r'co m p en satio n (a copy o f w h ich 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 iate o f C alifprnia. Y oh are fu rth e r notified th a t said application has, been set for hearing at ' ' - - '> . ' - L `' .; , ) - : . 4107 LOS ANGELES STATE OFFICE BUILDING, '107 SOUTH BROADWAY' ` \ V- . . ' ' - ' LOS ANGELES, CALIFORNIA . : ^ ' -, - October* 2 B, 1961i ' " ,9 :0 0 A .*t. a l l day and th at at'said tim e and place the Industrial A ccident Commission of the State of California will proceed to hear and dispose of the said application in the m anner prescribed by la w ... ~ _ ' ,, - _ ' N o te; T he parties are exoected to subm it all issues in controversy for decision at this hearing; therefore, all necessary witnesses, evidence, documents, medical reports, payrolls, and other essential proof m ust be available and ready for submission at the hearing. ^ - Dated: LOS ANGELES, CALIFORNIA - B/20/6k " , . INDUSTRIAL ACCIDENT COMMISSION " N ' *- * . 'HXLLI/ui RApL/Ji ' . ' - ./ /' " .. ` 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 ap plication 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 of business or residence, as follow s, to w it: , - ' - _ - . - - _. - . N am e and A ddress o f Persons Served . .. ' L. ' ^ A ' -Date Too a t fca c h a d Jo in d o r* f o r s e r v i c e . ( S I G N A T U R E QfT ptflSQN OCHVlCt NOTICK I i September 11, 196k A ' '* -T ' , * : Hr. B. R. Shriver - - -, -* V -' Alexander Agency/ Inc 316 Fourth Avenue . Pittsburgh, Pennsylvania 15222 ' ; ' : - : \ ' Bear Bev: ." ' - - . ; \ r' ' 1, Subjectt Sdward Novak . _ _. .'. (' ' Versus \ .?. V " . - Thorpe Insulation Comparty, et al ' lhe enclosed Notice of Hearing and attached application for benefits under the California workmen's compensation act was our first notice of this ' occupational disease claim. - > >l _ Since the Standard Accident Insurance Company insured Armstrong for work men's compensation liability during Mr. Novak's employment as an asbestos jworker from 1940 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 ment 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 Bociosures Wallace B. Hofferth Assistant General Manager Insurance Department - ;> \ ' V '\ ' -- " 5 ::r: Subject Edward Novak Former Employee L 1*' * f\AK V '. '. f t I Attached you will find a notice of a hearing sent to us by the Industrial Accident Commission, State of California. Y ou will note this hearing covers the proceeding for a former employee, Edward Novak, alleging that he is suffering irom asbe stosis. Vie a r e u n a b l e to a s c e r t a i n f r o m o u r p e r s o n n e l r e c o r d s the exact dates of employment, however, by recollection, it has been approximately ten years since Novak was in our employ. CH A.L. Stokely, San Franciscp 261-0216 CABLE AODRES5 AlEXCAND TELETYPE PG 891 A LE X A N D E R AGENCY, INC. I N S U R A N C E - W O R L D W I D E S I N C E 1853 316 FOURTH AVENUE PITTSBURGH, PA. 15222 September 14, 1964 (Monday) Armstrong Cork Company Lancaster Pennsylvania Attention: Mr. Hofferth Re: Edward Novak Gentlemen: Thank you for your letter of tthhee 1ab1otvhe.enclIoshianveg pfaoprewrasrded in connection with the Hearing of ccident in Los Angeles. your enclosures to the Standard A Very truly yours, B R S :e h Beverly R ; S h n v e r < O U R S E C O N D C SN TU R Y O F IN S U R A N C E S E R V IC E  // September 11, 19$*> / Hr. G. H, Finlay ,. Alexander & Alexander, Xn.C* 2225 Berth Charles Street , Baltimore, Maryland 21218 l/ sf \ \ , r /. ' v- V^ 'y^ " - \ 1 A, VH Bear Hr, Finlay! . ' ' Subject! M v a r d Hovak a7. . r- - Versus Thorpe Insulation Cocjpany, e . v-'! ,s* ' *' .. y . J [ . Jr v ' 1-. ' The enclosed Sotic* of ?or S t e ? s is Mr, Hovak s application ro < c c ^ ^ t l o i h e n e f i t s . The period December, 1956 and therefore 5 * % S ^ t S * & 5 ? * vas'on January 1, 195$* ; . _ rs ,s i ss'iisx'^sss.' 1952, the data the 'Travelers vent on the lino,. ^ .. . <SfSw % - , .' . ` -.. ... - ' notice of 'Bfedrici '* a t t e n d ' Sfic^ofih?- g f o r ^ i yp S u o f o f o\n^interests. Becelpt of these by tha Travelers is respectfully requested* ' ' ,- ' ' ...... -` Very truly yours, ' . . .- DJH ' Enclosures Wallace B. Eofferth , Assistant General Manager Insurance Department INTER 'OFFICE COMMUNICATION ' To M. K. Bare, Jr., Employee Relations, Lancaster L. T>W%i / ^ ' -P r --------A r m s t r o n g COM>AMV October 1, 196U From G. G. Patterson, South Gate Plant Subject Armstrong Employee Edward Novak 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 b y 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. should also go to M. C. Sweet, C. B. Sauer, and to me. Perhaps copies Thank you" for your assistance. needed. Please let me know if further information is Best regards, DS Enclosure Mr. V. G. McDonald Manager, Claim Department Reliance Insurance Companies 51|8 South Kingsley Drive Los Angeles, California C. B. Sauer Armstrong Cork Company 5983 Smithway Los Angeles, California 7A M. C. Sweet Armstrong Contracting & Supply U3U0 District Boulevard Los Angeles 58, California F O R M 1302 2- fl2 NO E N V E L O P E R E Q U I R E D Ti'5'" PP ; vV-''.VVVvC;. e *.03.*V .'r - " J. T - ' -;.iK.-'-'L S V i ' 'S# RELIANCEINSURANCECOMPANIES LOS AN GELES BRANCH O FFICE, 548 S. KIN G SLEY DRIVE, LOS ANGELES, CALIFORNIA 90005 T E L : D U N K I R K 5-7171 September 28, 1964 ^Armstrong Cork Company, 5983 Smithway, Los Angeles 22, C a l i f . Re : Claim No: 9 1 -C-436249 i Empi oye r : Armstrong Cork Company D/ !nj ury : J u n e , I 9 5 O Empio y e e : 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 e a r in g , naming your company as h i s employer d u r i n 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 yo u, and many o t h e r employers ove r the y e a r s , t h a t he developed a c o n d i t i o n w hich 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 r e c o ve 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 e s t we can d ete rm ine from the i n f o r m a t i o n s u p p l i e d , Mr. Novak i s supposed to have been employed a t your o f f i c e . We, t h e r e f o r e , a s k t h a t you ch eck your r e c o rd s and determine i f you have a record of employment of Edward Novak, and i f s o , the e x a c t dates of h i s employment, and where his personnel records would be. I f t h i s i n f o r m a t i o n i s o n l y a v a i l a b l e a t y ou r Home O f f i c e in P e n n s y l v a n i a , we would a p p r e c i a t e being n o t i f i e d p r o m p t ly , and being a d v i s e d to whom we should co rre sp on d 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 r y much appreciated. Reliance Insurance Companies 543 S, Kingsley Drive Los Angeles,' California 90005 Gentlemen* _ ' Attention* Mr, Y. C, IfcDonald, Manager > ... \ -A Claim Department. ' - - ' - . J-'.J - ' ' '. - ' - '' Re* Case HoV 63IA 250 854 - Claim No. 91-C-436249 ' - Employer Armstrong Cork Company '' , '. . . '' ` ' . ' " D/lnjury June, 1950 .. ' . Employee Edvard Novak y ;- . , ' ; . , lour letter of September 28, addressed to our office in Los Angeles, *'' has been referred to us for attention* " , ` . .. - We regret we 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. Train January 1, 1940 to January t, 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, 1958, ' ' 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 . . 1i^MtTri^.^-.fl-^T .a'^,1-m1 r%arfffyijnrf'-rrr"* - rir`1 /? THE TRAVELERS T H E TRAVELERS INSURANCE COMPANY T H E TRAVELERS INDEMNITY COMPANY CLAIM D EPA RTM EN T F rank O. M en n en , M anager _ October 8 , 196I4. LOS ANGELES OFFICE 3600 Wilshire Boulevard Los A n g e l e s, C a lifo rn ia 90005 Telephone: 381-2525 Re: Edward Novak vs. Armstrong Contracting & Supply Co Armstrong Cork Company I AC C a s e #63 L A 2 $ b - Q $ k iV i f i* 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, 19614letter and enclosures. We will represent your interest at the forthcoming hearing. 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 separate entity but that we can obtain employment records through your office. In other words, we will need the same information by Armstrong Contracting and S u p p l y as for A r m s t r o n g C o r k Company, If vie a r e i n e r r o r , k i n d l y a d v i s e to w h o m w e s h o u l d d i r e c t these inquiries. JB :mt 100 T I YEARS j v j or tu.ii.iCE fscuciici i / T T 1B0 1-IDC4 .V HOME OFFICE: HARTFORD, CONNECTICUT ~-'-w -`if \V-v/r. " IVv. 1 L '.f` '- _^ - '.-'li"I '' . . . , r VISIT THE TRAVELERS EXHI8IT JET THE fiW GRK WPSl S FAiR 261-0216 CABLE ADDRESS ALEXCANO TELETYPE PG 891 A LE X A N D E R AGENCY, INC. I N S U R A N C E - W O R L D W I D E S I N C E 1853 316 FOURTH AVENUE PITTSBURGH, PA. 15222 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 i /s Beverly R. 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 K- ; October 21, 1964 . .Vi. Res ` Edward;Nqyailys. ' i'ii ' Armstrong Contracting and >?v ' Armstrong 'Cork 'Company 1 IAC Cas #63 LA 25^85-4 1 - f Supply.. Corporation. ' J.-.- `-`.-.I. 'We have;'your letter, of .October 0. '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 Mr, Novak is.1940..^o .Deceml^jr^ 1 9 5 6 ; - _ . . . y e ^Mr. Novak ;did'not work for Armstrong Cork Company nor. Armstrong ; ;r 1 -/ r Contracting and'Supply Corporation during the past ten years._ We regret we cannot givs 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 From.Jan'uaiy 1, 1940 .to. January'l,?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^tojri, including Pecember, 1956. - * Armstrong Contracting a n d .Supply Corporation i s a ^named defendant even . though t h e 'oeriod of employment involved is.prior.to the formation o f - that company, which'was on January !, 1958. ' .On this date they' assum e d , f the contracting operations of Armstrong .Cork Company, - - ... Very .truly yours, Mabel E , Barnet . c . Insurance Department B \ BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as Fiherglas Engineering C o m p a n y ; 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 8 5 ^ 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, I 965 NAME AND ADDRESS OF PERSONS SERVED 3/8/65 See attached list for service. 1 , w . mar ( S i g n a t u r e o f p e r s o n servilLg" n o t i c e ) 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 B l v d *' T h o r p e I n s u l a t i o n Co,, 2741 S. Yate s , L A 9 0 0 2 2 Marine Engineering Co* aka Fiberglass Engineering C 5933 Telegraph Rd., LA 90022 Reece Insulation Co., 4563 Valley Blvd., LA 90032 plant insulation Co., aka Thorpe Insulation Co., 2 741 S. Yates Ave., LA 90022 Jackson Hopkins Co., Box 490, Bakersfield Armstrong Cork Co,, 5037 Patata St., South Gate Att: Ronald K. Wilson 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 C o . , 4 3 4 0 D i s t r i c t B l v d , , L, Plant Asbestos Co., 1540 W. 9th, Long Beach Pacific Employers Ins. Co., 4050 Wilshlre Blvd,, Fireman's Fund Ins. Co., Box 2323. LA 90054 LA 900 0 oonnS 9 5 The Aetna Cas. & Surety Co., 2404 Wllshire B l v d , , LA 90054 *The Travelers Ins. Co,, 3600 Wllshire Blvd., LA 90 5 R e l i a n c e Ins . Co., 5 4 8 S. K i n g s l e y Dr., L A 9 0 0 0 5 Qnnnc- W e l n g a n d , K e n d i g & Stockwell, 6ll S. C a t a l i n a , L A 9 0 0 0 5 * 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., L A 9 0 0 1 2 *Herlihy & Herlihy, 412 W. 6th St., LA 90014 Marine Engineering Co., 14301 Ainsworth, Gardena Argonaut Ins. Co., 1001 Wllshire Blvd., LA 90017 Industrial Indem. Co., Box 2252, LA 90054 Allen, P e t e r s e n & Mansell, 505 S. Virgil, LA Copy of application and Joinder filed 8/20/64 served. rs INDUSTRIAL ACCIDENT COMMISSION STATE OF CALIFORNIA AT*-** ft?I"*? Case N o . _ ** *Aa-v, .***& JL**& *.-*.V'- s m - ,i .* t **i -*i Applicant_ vs. 9 V ~^ct ,n*& catA^*? ri*.*$4* 4 {<rvX4 * &* ,^`*r%'yV- /" " ,-.R*-T\trt, 0 ' *^ 'i*u7r.'%V' -,*H#^A| N otice of Time and Place of Furtlier H earing D efendants ' J '. - \ . ; 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 . ...._. Dated at: LOS ANGELES fA ~ Vi5 i r, *,, * 'W A V , '-*' $ -H IN D U STR IA L A C C ID EN T COMMISSION N O TE : CO N TIN U A N C ES A N D FU R TH ER HEARINGS ARE N O T FAVORED. * -K ;/ fty --iS<;= >IS ts-w .C,-^-'-Vi: * DATE 3t y? W LT- r?* F o r m 4 0 0 - L (r e v . 2-s 4) / t \ - * * ' ___34772-502 1-54 i O O W j p o s r:it ra > : INDUSTRIAL ACCIDENT COMMISSION STATE OP CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as Fiberglas Engineer ing Company; et al Defendants C a s e No. 63LA 2 5 0 854 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 S O U T H B R O A D W A Y , L O S A N G E L E S , C A L I F O R N I A J u n e 22 & 23, 1 9 6 5 9:00 A.M. 2 d a y s Dated at: LOS ANGELES M / h 1 i 1365 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. H a y s , 6331 H o ^ y w o o d B d v d *' C o n o c o T h o r p e I n s u l a t i o n Co., 27^ 1 S. Yates, LA 9 M a r i n e Engineering Co. aka Fiberglass E n g i n e e r i n g Co., , 5933 Telegraph Rd., r l a r k B. R e e c e d ba R e e c e Plant insulation Co. aka 90022 Insulation Co., Valley o o Thorpe insulation Co., Blvd., 2 7 4 1 S. Yate Ave., LA 90022 J a c k s o n H o p k i n s Co., B o x W , _E a k e r s f i e l d Armstrong Cork Co., 5037 Patara St., So * Att: Armstrong CRoonntarladctiK-ngW iJl sSounpply Co District Blvd., LA ^W^Distri LA 90032 9005 M a r i n e ^ E n g i n e e r l n g h o ^ , 1930;^ - w o r t h , ^ ^ e n a ^ g0005 A / A J 3 2 3 oL A 90059 f e t TlnH ; P . r s. S t a n d a r d A c c i d e n t Ins. C. s u c c e s s o r cc i 548 Kingsley Dr., LA 90005 , Industrial Indem. Co., Box 2252, LA 90059 . Guarantee Ins. Co., 1671 Wllshire Blvd LA 9001^ oop S e r h f l H e r f i h y T i a I V 6 t k It!," ! a 9 0 0 1 9 . Spray, Gould & & P 5 Sunset M c L a u g h l i n , E v a n s , D a l b e y <* C u m m i n 0 , o Blvd., LA 90028 : o? p S & S f i i l " 8 / 2 0 / 6 9 & 3 / 8 / 6 5 s e r v e d . 1 .w.mar . , ' / / INTER 'o ffice communication (Armstrong C O N T R A C T I N G {L f it (Am CH ATie S t o k s l y , Saa F r a n c i s e s //!) FORM 1501 Printed in U . S .A . EFORfc M E I N D U S T R I A L A C C I D E N T C O M I S S I O N F THE STATE OF CALIFORNIA EDWARD NOVAK Applicant vs. MARINE ENGINEERING COMPANY, also known as FIBERGLAS engineering company; and PIBREBOARD 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 corporati be joined as parties defendant in the above-entitled cause. INDUSTRIAL GORDON W. W INB1GLER ' Referee ACCIDENT COMMISSION -. -5 Name and address of persons served See attached list for service. Date r 1. w . m a r , ( S i g n a t u r e 'l l p e r s o n s e r v i n g no,,._c_) 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., LA 9 0 0 2 8 Marine Engineering Co. aka Fiberglas Engineering Co, 5933 Telegraph Rd., LA C l a r k B. R e e c e dba R e e c e LA 90032 Plant Insulation Co. aka 90022 I n s u l a t i o n Co., 4563 V a l l e y Blvd., , , , 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., LA 90022 Jackson Hopkins Co., Box 490, Bakersfield Armstrong Cork Co., 5037 Patata St., South Gate Att; R o n a l d K. W i l s o n Armstrong Contracting & Supply Co., 4340 District Plant Asbestos Co., 1540 W. 9th, Long Beach Blvd., LA 90058 * 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 0012 * Flbreboard Paper products Corp., 475 Brannan St., San Francisco 9 4 1 1 9 . Att: M i s s D. Hanson, M g r . 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 R e l i a n c e Ins. Co., successor to S t a n d a r d 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 G u a r a n t e e Ins. Co., 1671 W i l s h i r e Blvd., LA 90017 * Pacific indem. Co., Box 3099* LA 90054 M c C o n n e l l & Cramo l l n e , 257 S. S p r i n g St., LA 9 0 0 1 2 Herlihy & Herlihy, 412 W. 6th St., LA 90014 Spray, G o u l d & Bowers, 1671 W i l s h i r e Blvd., LA 90017 M c L a u g h l i n , E v a n s , D a l b e y & C u m m i n g , 6725 S u n s e t 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 94104 * 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 : i/ STATE OF 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 Cas e No. 63LA 2 5 0 85^ NOTICE OF TIME AND PLACE OF FURTHER HEARING NOTICE TO ALL PARTIES You are hereby notified that further hearing will in the above-entitled action at 4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROA D W A Y , LOS ANGELES, CALIFORNIA held J a n u a r y 11 & 12, 1968 9 : 0 0 A.M. 2 d a y s Dated at: LOS ANGELES - NOV 1 5 1965 INDUSTRIAL ACCIDENT COMMISSION NOTE*. C O N T I N U A N C E S A N D F U R T H E R H E A R I N G S a r : N O T F A V O R E D . NAME AND ADDRESS OF PERSONS SERVED See attached Joinder for service. 1. w . m a r __ . (Signature of persTorTsIIRTIng n o t i c e ) / From M.C. Sweet, Los Angeles Subject Edward Novak Former Employee Attached to this communication is a notice form the Industrial Accident Commission, State of California" indicating that a further hearing will be held for Edward Novak, former employee, CH 3 FORM 1505 Prin ted in U .S . . -V ' v , -L'V- . :/V . 3* V -V. , A'"1. - 0/'-*-<-;V 0> * / V i . *' L j-' -n ' V"'V /:':1^ -h- ' ' \ *V hVVLV. -i.. ''-V f - m - Vs I-.2 ;l/t ' . INDUSTRIAL ACCIDENT COMMISSION STATE OF 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 j Defendants ) Case No. 63LA 250 85N NOTICE OF TIME AND PLACE OF FURTHER HEARING NOTICE TO ALL PARTIES You are hereby notified that further hearing ill be held in the above-entitled action at 4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADWAY, LOS ANGELES, CALIFORNIA January 11 & 12, 1966 9:00 A.M. 2 days D a t e d a t4- ,, LOS ANGELES N C V 1 S t 9S 5 INDUSTRIAL ACCIDENT COMMISSION NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT rAVOR~D. N A M E A N D A D D R E S S OF PERSON'S S E R V E D See attached Joinder for service. 1. w . mar (Signature of p e r s o n sexHTing notice) USTRIAL ACCIDENT COMMISSION BEFORE TH INO OF THE STATE OF CALIFORNIA EDWARD NOVAK Applicant vs, marine engineering company, also k no w n as FIBERuLAS engineering company; fv; and FIBREBOARD ,P ^ p UTCF l c rnRp a corporation; PACIFIC INDEMNITY COMPANY, a corporation) J A C K S O N P A C K I N G C O . , INC.., a ; corporation Defendants Case No i 6 3 LA 250 8 5 H ORDER JOINING PARTIES DEFENDANT GOOD CAUSE APPEARING THEREFOR: IT IS HEREBY ORDERED THAT JACKSON PACKING CO., INC., A ;e ioinsd as p a r t i e s d e f e n d a n t in the above-entitled c a u s e industrial GORDON W. WINBlGLER ------- ~Refere~er accident commission Raise a n d a d d r e s s o f p e r s o n s s e r v e d gee attached list for service. D a t e UQV ^ 65 1. w . m a r (S i gn a tu r e~V5T~person serving not Edward Novak, 4055 T u junga Ave., North Hollywood W i l l i a m T. Hays, 633I H o l l y w o o d Blvd., LA 90028 Marine Engineering Co. aka Fiberglas Engineering Co., 5 9 3 3 Telegraph R d ., L A 9 0 0 2 2 C l a r k B. R e e c e d b a R e e c e I n s u l a t i o n Co., 4563 V a l l e y LA 9O O 32 . ' . Plant Insulation Co. aka Thorpe Insulation Co., 2741 Blvd., S. Y a t e s A v e ,, L A 9 0 0 2 2 Jackson Hopkins Co,, Box 490, Eakersfield Armstrong Cork Co., 5037 Patata St., South Gate Att; R o n a l d K. W i l s o 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: 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 Wilshlre 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 Kingsley Dr., LA 90005 Industrial Indem. Co., Box 2252, LA 90054 Guarantee Ins. Co, l6?l Wilshire Blvd., LA 90017 Pacific Indem. Co., Box 3099, LA 90054 M c C o n n e l l & C r a m o 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 W i l s h i r e 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 9 0 0 1 4 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 a n d J o i n d e r of 8 / 2 0 / 6 4 & 3/ 8/65 s e r v e d . Av'> i i n t e r / ________________ _ - OFFICE COMMUNICATION To J, E . Zeller, Lancaster From / M C , Sweet, Los^ Angeles Subject S (j w a r c 3 u o v a k - -Former E m p l o y e e (Armstrong C O N T R A C T I N G January 11, 1966 Attaclae3 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 t h e i n s u r a n c e c l a i m of the above l i s t e d f ormer employee CH FORM 1501 Printed in U .S .A . =4 ' * ,, ^4x vu 0-U`jX " L do oa" U i - J - iXd O O ^ i O U 3 X .... W illiam t . h a y s HAROLD U GREENE W I L L I A M T. H A Y S ATTORNEY AT LAW au rrs: ta t-* q u a k a n t y s u iu a w a 1*31 H O L L Y W O O D I O U U V A D HOLLYWOOD, CALIFORNIA - 9005 HOLLYW OOD 2 -0 3 3 1 January 3, 1965 Industrial Accident Commission 107 South Broadway - Room 4107 Los A ngeles, California - ' ; Re: Edward Novak v s . Marine Engineering- Company, aka Fiberglas Engineering Company, et al ' . IAC Case No. 63 LA 250-854 , ` Gentlemen: \ ' \ ' . The attention of the commission is respectfully directed lo the case of J. W. Riley vs. Johns-Manville, et al, industrial Accident Commission case no. 57 LA 182-835. In the Rilev case, periods of employment which largely parallel tnose or applicant are set out with admissions of coverage and policy numbers, and^ will be of substantial clarifying value to all derencants , 1 regardin'! coverage problems. It is suggested tnau -or tne , ,t purpose f coverage', the record of this case be made available to the parties defendant. . . ;I -jj 'j Respectfully, ' : ; .. ' ' L ! - !; j WILLIAM HAYS / /\ r , j ? By Harold L. Greene Attorney at Lav/ WTH/HLG/h Copy - all parties or record per attached. .'-j OX iLJl'.Oj.X) W* .J f , i \ 3AdOO ^ H Edward Novak, 4055 Tujunga Ave., North Hollywood William T. Hays, 6 3 3 1 Hollywood 31vd., LA 90028 'Marine Engineering Co.;aka Fiberglas Engineering Co;, 5933 Telegraph Rd., LA 90022 Clark B. Reece dba Reece Insulation Co., 4 56 3 Valley Blvd., LA 90032 plant insulation Co. aka Thorpe Insulation Co., 2741 s. Yates Ave., LA 90022 ' Jackson Hopkins Co., Box 490, Eakersfield ^ -- Armstrong Cork Co., 5037 Patata St., South Gate ' Att: Ronald K. Wilson " .... " ' --- 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., 1 6 7 1 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 Spray, Gould & Bowers, 1 6 7 1 Wllshire Blvd,, LA 90017 McLaughlin, Evans, Dalbey & Gumming, 6 7 2 5 Sunset Blvd., . LA'90028 , !! Clopton & Penny, 6 3 9 S. Spring St., LA 90014 ` ' ' * Brobeck, phlegar & Harrison, 111 Sutter St., San Francisco 94104 1 1 " ' rj-- From Subject M.Co Sweet, Los Angeles Edward Novak - Former Employee \7 r- < \y Attached to t h l 3 communication you will find a notification from the Industrial Accident Commission, State of California, setting a time and place of further hearing for the above indicated former employee. CH / C'K (A FORM 1501 Prin ted in U .S .A . 'h f-L m :-  I S' ( 1 WORKMEN'S COMPENSATION APPEALS BOARD 2 STATE 0? CALIFORNIA 3 CASE NO, 6 3 LA 250-85^ 4 5 EDWARD NOVAK, ) 6 Applicant ) 7 vs, ) 8 MARINE ENGINEERING COMPANY, also ) known as FIberglas Engineering 9 Company; CLARK B. REECE, doing ) business as Reece InsuLatinn ' 10 Company; PLANT? INSULATION COMPANY, ) 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 INSURANCE COMPANY, Successor f-o ) Standard Accident Insurance } 21 Company; ARGONAUT INSURANCE C O M P A N Y , ) a corporation; PACIFIC INDEMNITY 22 COMPANY, a corporation, ) 23 Insurance Carriers 24 25 26 The parties to the above-entitled action having filed a 27 Compromise and Release herein, on .August 8 , i9 6 0 , settling this ca 28 for $5 ,5 0 0 ,0 0 , and requestor ~ 0 1-o0. +0- 4l b+- be appro 29 IRA RATNER, Referee, having considered the ent 30 said Compromise and Release, now finds that it 1 A 33 = O t il 1 2 3 4 5 S 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 GOOD CAUSE APPEARING THEREFOR: IT IS O R D E R E D t h a t said C o m p r o m i s e and R e l e a s e be, and Is hereby approved, and the pro c e e d s paid as follows: TO APPLICANT: $ 1 , 0 ^ 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, <Ur 7 n n n o ^ 3 0 0 . 0 0 b y R e l i a n c e Insurance Co, $300.00 b y I n d u strial Indemnity Co. ' $250.00 by Argonaut Insurance Co. $150.00 by Pacific Indemnity Co. $ 1 5 0 . 0 0 b y F i r e m a n 's F u n d I n s u rance Co. $150.00 b y G u a r a n t e e Insurance Co. T O W I L L I A M T , H A Y S , a s a t t o r n e y 's f ee: $ 5 5 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, e_r_e_c_ W O R K M E N !S ;e a f a t h e r /s/ b C T Y - o o COMPENSATION APPEALS BOARD ! I i ! i j i i [j ^ /->< a -'".'rr~'C* r>* r n r A D k t 1! 25 ; n a r c o a n 1 26 i; A u g u s t 1 8 1 0 0 6 (S E A L) K) CO 27 S E R V E D O K A L L PARTIES LIST E D OK OF F I CIAL ADDRESS RECORD, 29 August 1 8 3 i 9 6 0 By S, M A T 3U M O T O 30  f% t ans. ?Offf MJ! VM !CAT! 8N T'tT-itk T*-- 7. ^.c^ter -V *< (A rm strong contract!N G August 19, 1966 r, V.;, M.C. 5 . t . A^ "lss ' ,,W /a \\y Of Cr hhpe friinnaa.1l rr uuluinn^g by the Wor- kmen's Comp- ens,ation 1 | W 0; j-~o t C a--vU**^f*S---t*n-'l a , c_o_n_c^evr-nnTi-nn^g fthhpe Aabboovvee llii ss tt eedd 3ord, Stat" c^plyae' G 1 ? i ? V * 1 ii i ' h I FORM 1501 Printed in U.S.A. 1 cx / /// \ TM-V- ; ; -j OOyn - v_ - -- i f v ir- l.' K . * "