Document qd54O4MMrBNdER45g5daGDmvn
FILE NAME: DDd DATE: DOC#: Dd OCUMENT DESCRIPTION:t
!~;'l [ , '~ /
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Et<lPLO~ER
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1 DEPENDON ROOFING CO.
3521!N. Cicero Avenue
Chicago, Illinois
ATTACHED SHEET PAGE ONE
QUARTER PERIOD OF EHPLOYMENT
3/31/40, 6/30/40 9/30/40, 12/3L/40
THERM-O-PROOF INSULATION CO. 4730 Armitage Avenue
Chi~ago, Illinois
12/31/40
DEL E. WEBB CONSTRUCTION CO. & 3/31/41, 6/30/41 \vhITr: & HILLER CONTRS., INC.
Fart Huachuca, Arizona
O'MALLEY PLASTICS, INC. P.O. Box 3558 Phoenix, Arizona
3/31/41, 6/30/41
A.N. BORGQUIST P.O. Box 6134 Phoenix,Arizona
6/30/41, 9/30/41, 12/31/41
STANDARD ROOFING & SUPPLY CO. P.O. Box 2204 Phoenix, Arizona
6/30/41, 9/30/41 12/31/41
DEL E. WEBB P.O. Box 7588 Phoenix, Arizona
6/30/41
A.O. MILLER CO., INC. 220 Nordina Street Redlands, California
6/30/ 41
C.C. HOORE & CO.
Engineers Unit X-I 450 Mission Street San Francisco, California
9/30/41
MC CONKEY, DOCKER & CO., INC. 130-32 \'1. l1adison Street
Phoenix, Arizona
9/30/ 41, 12/31/41
W.A. BECHTEL CO. 155 Sansorne Street San Francisco, California
12/31/41, 3/31/41, 6/30/42
CONSOLIDATED ROOFING & SUPPLY
CO. P.O. Box 614 Phoenix, Arizona
12/31/41
MARINE ENGINEERING & SUPPLY 941 E. 2nd Street Los Angeles, California
12/31/41, 3/31/46, 6/30/46, 3/31/47
INSURANCE CARRIFR Unkno\<Tn Unknown STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA Unknown
STATE OF ARIZONA PACIFIC EMPLOYERS INf,. CC INDUSTRIAL INDEMNITY CO. STATE OF ARIZONA
PACIFIC EMPLOYERS INS. C(
J.T. THORPE, INC. 9A8 E_ 2nd Street .__~s Angeles, California
HUNDET CORK CORPORATION 7101 Tonne11e Avenue North Bergen, New Jersey
12/31/41, 6/3n/45, 9/30/45, 12/31/45 3/31/46, 12/31/46 3/31/49, 12/31/58 3/31/59
6/30/42, 9/30/44 12/31/44, 3/31/45 6/30/45, 6/30/46 9/30/46, 12/31/46 6/30/47, 9/30/47 ~/30/48, 3/31/48 9/30/60, 12/31/47 12/31/60
PACIFIC EMPLOYI:RS INS. C(
&
AHr.RICAN MOTORISTS INS. cnr1PANY
Ar,TNA CASUALTY & SURETY INSURANCE C0l1PANY
&
PACIFIC E~lPLOYERfi INS. C(
THE ASBESTOS & HAGNESIA HATERIALS CO. 119-127 N. Peoria Street Chicago, Illinois
6/30/42,
9/30/42
Unknown
SLATTI:P.Y & COMPANY 1726 Market Street Denver, Colorado
12/31/42
Unknown
FULLER-THOMAS CO. 118 S. 5th Ave~ue Tucson, Arizona
3/31/42, 12/31/42 3/31/47, 6/30/47
12/31/48, 12/31/49
STATE OF ARIZONA
YOUNGS SALES CORP. 1054 Central Industrial Avenue St. Louis, Missouri
9/30/45
Unknown
UNITED CORK COMPANIES CORP. Ft. Central Avenue Kearny, New Jersey
PLANT RUBBER & ASBESTOS WKS. 537 Brannon Street San Francisco, California
3/31/4~, 12/31/51 3/31/52
3/31/46, 12/31/46
LIBERTY MUTUAL INS. CO. SELF INSURED
WARREN & BAILEY CO. 3528 S. Garfield Avenue Los Angeles, California
12/31/46, 3/31/47 9/30/49
Unknown
TECHNICAL SERVICE COMPANY 423 N. 1st Street Albuquerque, New Mexico
6/30/47
Unknown
LEROW COMPANY - 5510 Sheridan Road
Chicago, -Illinois
6/30/48, 9/30/48 12/31/48
Unknown
ASBESTOS ENGINEERING & SUPPLY CO. 12/31/48, 3/31/49
18aO W. Fillmore
6/30/49, 12/31/49
Phoenix, Arizona
STATE OF ARIZONA
RI:FINERY MnINTENANCE CO., INC. 2500 N. Alameda Street Oomp~on, California
3/31/49
Unknown
STf'J\IH1S ROGER CORP.
fifin n~nnn~k S~rnn~
6/30/49
STANDARD ACC. INS. CO.
y T~~ORPE INSULATION CO. 2141 S. Yates Avenue Los Angeles, California
THOMAS H. HOGAN CO. 1591 Indus Street Santa Ana, California HALL INSULATION CO. 2633 E. 3rd Street Tucson, Arizona
KIRCHER, ASBESTOS & RUBBER CO.
Inc. Box 6652 Phoenix, Arizona
BARRETT & H0l1ES 6033 N. 10th Street Phoenix, Arizona
9/30/49, 12/31/49 6/30/59, 3/31/63 6/30/63, 9/30/63 12/31/63, 6/30/64 9/30/64
9/30/49
3/31/50
12/31/50, 3/31/51 6/30/51, 9/30/51 3/31/52, 6/30/52 9/30/52, 3/31/53 6/30/53, 9/30/53 3/31/54, 6/30/64 3/31/55, 6/30/55 9/30/55, 3/31/66 6/30/56, 9/30/56, 6/30/57, 9/30/57 3/31/60, 6/30/60
12/31/50
PACIFIC EMPLOYERS INS. CO
&
FIREHANS FUND INS. CO. Unknown Unknown STATE OF ARIZONA
STATE OF ARIZONA
ARMSTHONG CORK CO. Liberty and Charlotte Streets Lancaster, Pa.-
9/30/51, 12/31/56
STANDARD ACC. INS. CO. RELIANEL INS. CO. THE TRAVELERS INS. CO.
REECE INSULATION CO. 4563 Valley Boulevard Los Angeles, California
ACCURATE INSULATION CO. -900 S. Cypress La Habra, California
JOHNS MA.WILLE SALES CORP. 22 E. 40th Street New York, N.Y.
COAST INSULATING PRODUCTS 2684 Lacey Street Los Angeles, California
OWENS CORNING FIBERGLAS CORP. P.O. Box 901 Toledo, Ohio
9/30/56, 12/31/56
9/30/56, 12/31/60 3/31/63, 6/30/63
12/31/56, 9/30/57 12/31/57, 9/30/58
12/31/56, 9/30/59, 12/31/60
3/31/57, 12/31/57 9/30/59, 3/31/60 9/30/60, 12/31/60 12/31/61, 3/31/62 6/30/62, 9/30/62 3/31/63, 9/30/63 3/31/64, 6/30/64 9/30/64, 12/31/64
Unknown (moved no address)
CASUALTY INSURANCE CO. OF CALIFORNIA, INC. & STATE COMPENSATION INS. FUND
SELF -INSURED
ARGONAUT INSURANCE CO. STATE OF ARIZONA
THE AETNA CAS. & SURF.TY Ins Co. & THE TRAVELERS INS. CO.
,-
ATTACHED SHEET PAGE FOUR
JAl-tAR OLMEN CONSTRUCTION c/o P.O. Dox 14322 Houston, Texas
9/30/57, 9/30/58
ORIN A. WILLIAMS & JOHN S. GREEN 3775 N. 36th Avenue Box 11098 Glendale, Arizona
12/31/57
INSULATION & SPECIALTIES INC. Box 3428, Sta. A .E1 Paso, Texas
12/31/57
l1ETAL CLAD INSULATION CO. Dox 178 Torrance, California
BOB GRIFFIN ROOFING &
..
INSULATION CO., INC.
151 E. 24th, Street'
Yuma, Arizona
3/31/58, 6/30/58 3/31/58
FIBREBOARD PAPER PRODUCTS CORP. 6/30/58, 9/30/58
1789 Montgomery Street
12/31/58
San Francisco, California
WESTERN ASBESTOS CO. Box 3784 Rincon Annex San Francisco, California
3/31/59, 6/30/59
PLANT ASBESTOS CO. 1300 64th Street Emeryville, California
9/30/59, 9/30/fiO 3/31/61, 6/30/61
R.T. DINWIDDIE, INC. 8627 S. Atlantic South Gate, California
6/30/59, 9/30/59
INSULATION SERVICE INC. Box 4695 Tulsa, Oklahoma
12/31/59, 6/30/59
LOS ANGELES CORK CO. 4180 E. Washington Los ~ngeles, California
12/31/60, 9/30/G4
) ARMSTRONG CONTRACTING & SUPPLY 6/30/61, 6/30/65
CORP.
9/30/65, 12/31/65
120 N. Lime Street
Lancaster, Pa.
UNAFMX CONSTRUCTION CO. 1242 Abbot Dr. Pittsburgh, Pa.
9/30/61
Unknown STATE OF ARIZONA
Unknown AETNA CASUALTY & SURETY INS. CO. STATE OF ARIZONA
SF.LF INSURED STATE COMPENSATION INSURANCE FUND INDUSTRIAL INDEMNITY CO. Unknown Unknown ZURICH INSURANCE CO. FIR~tAN I S FUND INS. CO. THE TRAVELERS INS. CO.
LIBERTY MUTUAL INS. CO.
. .,.... _ If .
ATTACHED SHEET PAGE FIVE
UNAFRAX CONSTRUCTION CO. 1242 Abbot Dr. Pittsburgh, Pa.
9/30/61
INDUSTRIAL SERVICE & ENGINEERING CO. OF CALIFORNIA
Box 16138 LO,ng Beach, California
3/31/63
KITZHANS PLUHBING & HEATING 6940 Alvarado Rd. Lamesa,Ca1ifornia
THE ISOTHERM CO. 605 Williams Bakersfield, California
THERMAL ENGINEERING INC. Hoffman & So. lOth Street Richmond, California
BALDWIN, EHRET, HILL, INC. 500 Brevnig Avenue Trenton, New Jersey
6/30/63 6/30/64, 12/31/64 12/31/65 12/31/65, 1/1966
LIBERTY MUTUAL INS. CO.
LIBERTY MUTUAL INS. CO.
INS. CO. OF NO. AMERICA
SENTRY INS. CO., a Corp. Unknown
LIBERTY MUTUAL INS. CO.
&
INS. CO. OF NO. AMERICA
GOOD CAUSE APPEARING:
The ~pplication herein is taken otf c.1lendar.
I:'llll, weA..
DATI
Department of Industrial.Relatiol\s Division of Industrial A,cc:ident.s
Workmen's Compensation Appeals
State of California
APPllCAnON ;~~R ,II . FOR ADJUDICATION OFJnAIM
(Death Case)
pleau file sigHed original arId ,ix copier a"d pri"t or type Hame. and addreues
""\\I~U
::;,:t1S 1 \'
,.\~\(. I.i:..S Bo~rd
AMEMDt6 APPLICATION
66 LA 292-043 CASE NO_.- - _..... ,---..~..
MI Mrs. Mils/
Maurine Clark
('P'LICA"'
(w~dow)
----------------D--e-a-n---C-l-a--r-k (Deceused)
____l}~~~~~}~~\~02(,} ~_0u 1 ev ClrsL__tliJj)
t"'lIC'NT S "DOl""
_____Dm-JJ\ey, CalAfornia
-ranTlfl'ti i 'hatE i N~
vs.
---------------S-e--e-attached sheet ( . IIl~LD . . 1
11.,LOY'.'1 'OOltlll
_ _ _ _ _ _ _ _ t -!:S~e:::..:e=___=a~t ac hod shee t=--_ _
C'.'LOY,I IINIU.ANCl CAIUIII 01 ITATI I' .'L'IH,U.'D Ollt 'll IIIILY UH,M'UIID)
------------_._----------------- IADDI'SS 0' IHIUIANCE CAI'I'", "ANY)
IT IS CLA IMED THAT:
I. Deceased (mployee: born
on 194 Q-1 9 6 6
(DAll 0' lin. I
, while employed as a __A.~.l?estoJi JvosJ<.~r
OCCUPATION AT '1M' 0' IN)U"'~
, at Various places
I CUYI
_____ , by the employer sustained injury arising out
(nAUI
of and in the course: of employment to _ _-,l=-u~n:.;;g~_ _ _ __
II'ATI W"AT ' .... '10' 100'( W'"' IH.lUIU')
2. The: injury occurre:d as follows:
Inhala tiQ1LQf asQ.~st_Q.s~.nd Qt.hJ~r._ tQXeJg.TL...S.ub.S..t.anc.e.~_ .'.PL.... W"Al '.PLOY'I WAS DO"'. AT liM' or 'NIU" AND HOW fHJU., w,. IICtiVIO,
resulting in death on --.M~j~.9Ji6_.
(DATI 0' DUTH I
._--- ------- - - - - l. Actual earnings at time of injury were: _________ ,O.VI WI'lLY oa .ONTHLY ,AL , 01 HOUllY I.TI AND MU."I 0' HQUtl. WOI"IO PEl WII.)
... The injury caused disability as follows: ____________________________________
(Uleln LAIT DAt D" wo" DUt TO T.III~JUn A~D "GIHNING AND I"DI"O DATU 0' ALL ,UIODI 0 " DUI TD THll INJUIYI
So Compensation was paid_ _no.. $_ _ _ _ _ __ $
("'I
(MDI
(TOTAL 'AID I
(WUOLY "HI
f DATI 0' LA.T PA, .. INT I
6: Medical treatmrnt was r(ceived ~eL- _ _ _ __
All treatment was furnished by the employer or insurance
UUI
I NOI I DAll 0, un lIUHU"TI
comp:my __
,".)
other treatment was provided or paid for by
'NO'
Doctors /lot p'rovided or' paid for by employer or insur;ance company, who tre:ated or examined for this injury are:
_ _ _ _---::S'-'t"-'.~F'_'~ancis lIospi tal, 3 G3 0 ImpQ..rj,a:LlIigDHuY..,,--I.oIYll'tlQ.09 ~CalllorniQ_ ,ITAl' "AIU. A"O 60D.'111. 0, lUCK DOCl AND H'M" 0, "OaPiTAl' TO WHICH IUCH DaCTO ADMllllD UUU.IO'
7. Defendants have paid burial expense.
ItU.
TOTAL PAID _ _ _ __
INOI
8. The employee left surviving him the following de:pendenl$:
NAME
None
DATE OF BIRTH (if under 21)
RELATIONSIIIP TO TilE EMPLOYEE
ADDRESS
WHEREfORE, applicant requesu a hearing and an awn.j of: Death bencnt-X Burial cxpcnsc__ ),l. Compensation accrued and unpaid~ Unpaid Medical bill~ Other_ _ Specify:
and all other appropriate benefits provided by law
f '
Set now - - i Set bter on written rC(jUCH _ _
1 ~ "A,3' . \,". ()l . ymplcI",III.O""U"IJ,>('''V'Oi1r[n-c,'
F \ - . - . - - - - - - - - Cill i fornl l.ofr-AnCfe-l("~ 'AD~"(I' ''''0 TIUPH("IN( HUIIIII'_ 01 ""OIN",
, .
1\1' l ' LIL.A 1 ~Vl~
" t.
,['. . : (Death Case)
~(':
1.,1\
( : 9 FILE SIGNED ORIGINAL AND SIX COPIES
,,. J. /,' (PLEASE PRINT OR TYPE NAMES AND. ADDRESSES) ",/
_ _ _MAURINE c.LARlL1W.id_....../-)____
CASE No.
"to' , ,
,
1
i
1."1' ' ,. I
i,J I
.,- ,; f ."
I',
I
.--l.l3.3LLakewood..-Boll 1eva rd. B,..,1Cl--
_____.......- ~ ,,"L.ICAMT
A'PLICANT'1 ADDU II
- ________ ~D~E=AN~~C=LARK -~
(Deceased)
_...... ""...... _............
,-Downey, C~ifyo.r~n~i~.~..---..---------
__Dean~hark (Dec.) 88# 327-07-9443
OICIUlD IIl,Lonl'l NAil' AND 10CIAL ,'CUUlT MUllin
'-cc>nt'racting-Division, Post Office
r BALDWIN EHRET-HILL, INC....:.,._ _ IULOfli
_~.ox_!}um~~r 34126
',,'LOfU" ADDU ..
.,
INSURANCE C~. OF NO. AMERICA
'II'LOfU'1 INIuaANCE C,,"lrA 00 IUYl If ICL',IHSUUO oa ".IIIIIIILY UIIIN,UI'D
__~21 SQu th V i ~j~.-f\venue
IN,UUN" CAUIU', ADDU..
1/ . 1. It is alleged thaL.De.aILC.~..::-~P-e5:..eased)
- "II' 0' '''PLoni' .'-- -. - -
_J.21..2Ll9.07
DAY' 0' 1I00H
, while employed as a
_ _ _.Aabe.a..to.S..-WO.rk.el:..-.
OCCU,ATION AT TIN' 0' l"lUI,
by
Baldwin-Eb ret.=Hill#-Inc.
NAN' 0' IN'LOYU
to _ _ _L...IA.llc.LN.,.G . ~_ _ _ _ _ _ _ _ _.
rUTI 0, 10DY
on J9.4Q_ t.o~____ I9-6..6_. at ..Y_a..r..i.9us place~ California,
' .' . DATI 0, INJUIY
~
J sUHainc iRjury
. :ll'1sing
(\ t' \. .,. L
out of amI
,tC I T Y . " I
I ..... \, ...
-I W ,t J(.
in the cou'rsc of employment
,{
'
, as follows: _~NIiALATI.ON. _<2f....ASltf;S.TOS AND OTHER
flrLAIH HOW INJURY WAS IIICIIVID
_ _ _...F.. ...,ORE..lGlLSUBSTAN""'C""'E..S. "-_ _ _ _ _ _ _ resulting in death on March L.J..9_6...~6_ _ _.
DATI 0' DIA TH
2. Employee', actual e:lrnings at time of injury $_?_____at__________. The basis of pay was:J-_ _ _ _ _ _ _ __
WIU 01 1I0NT"
3. Was compensation paid? ____
UI
NO_ _ .
NO
$_ _ _ _ _
TOTAL 'AIO
$_ _ _ __
WUKLY UTI
OUt 0' LAIT PAYMlNT
,-4. Wa. medical treatment received? -YES..-
UI
110
DATI LAIT 1I~1IV1 0
Was all medical treatment provided by employer or insuran'ce com\?.Iny?
Tn
NO
If no, state who provided il. _ _ _ _ _ _._ _ __
/ Lynwood ----S'r--E.Rl\NCIS HOSEITAL---16.30-Imp.c.riaL.High\tlay-+-_1i'.mm~ _Calilornia
ALSO .TATe NANU AND ADDUUU 0' ALL DOCTOI. WHO TOUTID 01 IIAII,"'D rOI TItIS l"lUI.
1. Has burial expense been paid? ____ n.
6. This application is tiled (or:
$ - - - . Who paid it? ________________
NO
, Death bc:neftt_~XI.-_ Burial c:xrcnseac.._ _ _ _ Compeos.ltion ;u;crucd and wlpaiJ _ _ __
Other_ _ _ _ Specify: _____
7. The employee le(t .urviving him the following dependents:
NAME
NONE UI '{(lll".d..(!~.~
AGE
/II' UNO':" 2\)
(',
RFLATION~HIP
TO THE EMPLOY~E
__._ .-~~~~--t~.. -
.'':'~l
ADDRESS
--, '-'-'- ----------
IMPORTANT-If any :1pplicant i! under 21 ye,lrs of ~~e. it will he m'Ct'~\.lr)' to file I'.'lilioll fClr Appuinll11ent o( GuarJi.ln ad Litem, l:orms (or this purpmc molY be ohtained :It the utlile (Ii the ll1dll~1 ri,li A\:ciJellt COlllllli,~iun,
WI IEREFORE, ajJplicanl rl'qlltsls a br'aring a".! all awarJ /'" .. /I ajtJJrol"ialr' /Jr'I"'jils bt is rlllillt-J III by 111141.
DJtcd at__~~_ !-~ge_~es _. Colli{()rni;J~.:_~.!:ch 22/ } 966
- . . . . '.--- Hcuing reque.sted H ___L_o.s__A_n_g_e_ le_s ._____
, -) ) 1
_ CITT.
~' ,...-- / / / ' ~ (V-:~ '--",-..- ~~ -L
"'~;'
DA Tl ",
_~ ,-!-. ~t.._1:..~_._
-J_ EHimated lime of tri~I_____(If_f ____
.
/D.,,~,
__/ _____
_~W_.9FLr::..I~_uC:;c_i_SS!'"t~~.TLU.."'fE._~'..dr'"ROS~AN
__
_
I
"" . I(AN," AT.O ... H(, 01 .[".'I~"flTIV'
s \}., Plule !oCt now ___ set Ileer 011 written requeH _ _.
_ '____ ~61~, ~~.th t. .
(Du 5 -3071)
.. f):1 g, . ,~ .... I' ,t , I I" , ... r "' t .. rt, N ' r A' 1
"'_ ," r ~I ",TI TI .... '
.. P,
APPLICA TION
FILE SIGNED ORIGINAL AND SIX COPIES
(PLEASE PRINT OR TYPE NAMES AND ADDRESSES)
Dean Clark,' ArrLlCANT Social Security No. 327-07-9443
Baldwin -Ehret Hill, Inc.
'MPLO'"
',6l}', (~9 2 0 ~ "], ".
CASE No. 13331 L[l}~c\"o()d Boulevard
A'PLICANT'S ADOH["
DOvllley, Ca l.i forn-i-a---------------------
Telephone No, _ _. ______.____._________
S(,l11 FruDcio.co, Ca l-i-f-o--r-n-i-u------------
,N.uiiAHC-,c-uli',"'u-'.-A-OO-.-l:cb" : " - - - - - - - - -
IIAM' 0' EMr~O'LL
"1l 2/...-2/-1.'~--0-'/._--, wh.'tle employed OIl-
Dur 0' .,ITII
1940-1IJb6
DATl 0' '''JUt'
19._
bf as a-.a.heJit.QlL}mrker
at _ _yar iOUs._l?J.2ces I inc lu<.1i.!!S.-.San___, California.
OCCUPATION AT TIll' 0' UUUIY
cln. 10WII Ot ruCI Wllnl "<JUt, OCCUot'D F r a nc i SC?
by Sa Idwin=Ehr.e t...liilL_IIlC '. _.______ sustained injury 2risi~g 'out 0' and occu~rGtg in the c~~r}e ~h:
employment.
111011' or IMr~o".
Luo~
STAn - - - - - - - - - - - - - - - W"4T PUTS 0' IODY ....., IIIJUIlO 10.. 0 'U.UOUllI' 'UU~lI
of or.e..ign .. Iollal atj 00
asb.cst'>~L.s;m.~L~.tl~r
.\lh~.t0I."t9!3::..:s~_ _
1&,UUf WHAT '.PLO'IL .A' OOU" AT "M' 0, UUUIt' A"O HOW IIUUJI, WAS .lC"~D
2. Actu:lI earnings at time of injury $_______per_ _ _ _ _ _ The basis of pay was: _ _ _ _ _ _ _ __
WUI 01 MO",H
nATI rAY rUIOD
O. IIOUILT lUI, HOUII A DAY AIID OAT. A WI . .
3. Periods disabled for work.: --.lr;r;an~t~~l-:..au.U- since.-&!.a.nuru:..:'J4.-19b.6_. ._ _ _ _ _ _ _ __
.,U:lrY UIIINIIINO AIID INOIN!! DATU or ALL PUIODS orr ...DOK OUt TO TIll I INJURY
_ _ _ _ _ _ _, Date returned to work.__________.____
4. Was compcns2tion paid?
TEl
10
TOrAl PA'D
WUKn UTI
_._- -'-'-
---_ _.----------_ - ...
..
OAl[ 0' LAir pnlHNT
Have you received Wlcmployment or unemployment ~umpcruOltion Ji:iOlbility benefits since the date oi injury? _ __
Tn
NO
So Was medical treatment re~eived? _.:iQ..fi.
State date last received: _ ._~urrC?n.~_l_A.y____ .________
'"
110
Was all tcutment provided by the employer or insurance cumpany?
'" If not, state who provided it. _ _ _ _ _ __
n o _ _.
NO
Also state names and addresses of all doctur~ who treated or examined for this injury, ._ ~~!.Xran.<::is _lI~.~~_a_l_ _
----------------_._-------_ -_._-- _...
6. This application is filed because of disagreemcnt !e);JrJill~ liJbolity for:
..._..-.- ...._._.- -.. -.
Temporary disabilitY-yes- Permanent diubility. _ y.es Proper COllllwmatill1l R.ltl .. yes
Self-procured medical costs_-yes-- l.iti~;'Ition emrs y~ _ Mcdic.1I tn',lll1lelll yen.
Othcr__y-esSpcdy: ___ i.mmc.!d.iiltC...m.eULCJ'l.L ~~ tmc.u t .. <:I.n. ..~.\!r<;lQry.
7. Have you ever had a case for another injuq' be[on: the C~li(orni,1 ClIlImission? _ .___ ..__ .
Los ]\ngQlc~>
Ileuing rtque~ttJ at _ - - - - - - .
- ellY Estilmted time of triaL______.... PltJsc: 1Ct no\\' _ _.; set 1.Her on writ ten rcquc~t ____ ,
_Lill'J."'01:lC.l::.L Ql:~.. STEVJ:;N~~Q~.8.r~N Al'ttllCANY ,. "'IIUIINl, OM .,'ltl!.1 "'"'Jl/t
s~_
CQ (,'~(' f'''I,tc:....,.
..-.:I:n\ -\ i~ \ C (c..\ "'" _
.&.IdVJ \'", - _ },re.+_ 11;/1
______ + _ !!1~~.d~+~_eo r _~
( f
Or,~ S ,._o~ .. c::'f f:::.. .____,____:_~____. ____.___ .._____~____..________.___ _ ,.
__"~-o h~_-ro CX1\\J; rl-~- _____._.~~~~------..-----.--- __________.___'_~._
,. __ . ___ ...__............_. _ __...--.. _ _ _ - - -___-___,__ ____.__ ._ _ ____..J-_._______ -.~___,..
.~
~, ~
-,,~~~
~.~,
~
-..< _
_ _ _ ,.~ _ _ _ _ _ _ _ _ _ _ - - - ~~ _ _ _ _~_ ~ _ _ _
- _ --.-.......,~~ . . . . . '.-"'l""!"~-
... -.~--~~-~ ----------------"~ -------~- __ -"'----.... ._-
__ ---------------,-"_.---,---'-;,:--- -~.,---,----, ---------~------ - :..;..;... ----_._-----'----- .
._---_._._--_.-.-._-.-
- - - - - - - - - - - - - - - - - - - - ---~-"------- ..-----------------~-----------------.--------'----,
, .'1'' _' .;I'
, ' (
. ~, "'
f' t
It
"I,, ,I \ ~
. .'
\.~.
/
1
WORKl-lliN'S COMlJENSATION Al-'PE1J..S BO.fiD
2
STATE OF CALIFORNIA
3
CASE NO. 66 L.A. 292-043
!'
MAURINE CLARK (Widow), DEAN CLARK (Deceased),
. ) . .
)
VS.
)
8 BALDWIN EHRET-HILL, INC.,
)
et al,
9
)
ORDER Al--t'ROVING COMPROt1ISE AND RELEASE
10
Defendants. )
11
12
The parties to the above-entitled action having filed a Com-
13 promise and Relea~e herein, on June 13, 1969, settling this case
14 tor $;,410.;0 in addition to all sums which may have been paid prev-
15 lously, and requesting thAt it be approved; and this Board having 16 considered the entire record~ including said Compromise and Release,
17 now finds that it should be approved; and
18
IT IS ORDERED that said ComproMise and Release is approved.
19
AWARD I~ HADE in favor of: MAURINE CLARK
I
20
AGAINST: HARmIARE HUTUAL CASUALTY COMPANY; INDUSTRIAL INDEMNITY I
I
21
EXCHANGE; INDUSTRIAL INDBMNITY COM~ANY; INSURANCE
I
22
COMf'ANY OF NORTH Al1mICA~ PACIFIC El1rLOYERS INSURANCE
23
COMfANY; Ht;LIANCE INSURANCE COMl->ANY; THE TRAVELERS
24
, ....... , . INSURANCE COMPANY; FIBREBOARD CORPORATION AND l'LANT
215
RUBBl!ll ASBESTOS WORKS; FIREMAN'S FUND INSURANCE COHP-
28
ANY; ARGONAUT INSURANCE COMPANY; ZURICH INSURANCE COMf',
27
28
ANY; CASUALTY INSURANCE COHIJ ANY OF CALIFORNIA; AMERIC~ HOTORISTn I~:SUftlJI-';E COl~PANY; STATE COHPENSATION INSUR-
29
ANCE FillliJ; LIBJill TY HUTUAL INSURANCE COHPANY.
30
-1-
. '
-.
1
2
3
4
5
8
7
8
9
10
11
.--
12
13
14
15
18
17
18
19
PAYABLI:: AS FOLLm::;:
By: FIRE!1JJ-P C FUUD INSURAl;CE COMPANY
To: Applicant
.$ 48.53
Dr. John Fiel<}
200.00
Attorney Steven Rosem&n, for co~ts
86.47
Attorney ~teven Roseman, for fees
?OO.oo
$1,035.00
235.00
INDUSTRIAL INDEl:NITY l:.XCllANGE INDUSTRIAL naJEt!N!TY CO~~~Al~Y
333.00
414.00
InSURANce; Cma'iJlY OF ::ORTH A11ERICit. RE!..I/JWE nl~URANCF, COlU'ANY
180.00
81~6 .00
67 So",
TIlE THAVELER3 nWURANCB COHP;JIY
621.00)
FII3REnOARD conl'CIU~TIrN AND l'LANT RU13Bf.'R I\S13ESTC!J ~'lCRK~
C:l::U/~TY INCURANCE COEr- ANY OF CALIFORNIA
180.00 39.00
/JlGOIL'\UT INSURAN:E COHPANY
65.00
ZURICH INStffiAUCE COl~P1JJY AHl:1UC/Jl l1OTORI~T3 IHCURAHCE COHPANY
90.00 450.00
STATE COHPEIlSATIOn INSURANCE FUND
585.00
LIDERTY HUTUAL III:.JlffiANC~ C0!1rANY TOTAL
270.00 ~5 ,410.50
l;/ORKMEN t S
LOS fJ:GELES, t..:ALIFOHNIA
26
August 28, 1969.
27 1
I
j.
28
29
~11 PDrt~e~.ser~ud
1... 30
-72./-J..l- ;9'-. ,; :;. ;t.; . ~_l.;;..t_",'-1--1_ _ _ _0. I;' 0 / (/)
:?t}~-clt j/' 66 :"4\
-:'-
..........--..... ::-:.-N=:::"'- I.on'''' ...._ .1
Iltlati_
011.". . . In.... t.... ACCld",h
A".... Ikard 11_ ...... ,..,...
-~~f~ .. ' .... 5-66)
. .t,
, . ,
4.'
"
o~ \\}~\\ ,}./~ "J' V
1
S COl~~SATION A1PEALS BOARD
2
ST;yf:01" CALIFORN,IA
3
CASE no. 66 L.A. 292-043 .
' ...
4
5 MAURINE CLARK (VJidow),
)
DEAN CLARK (Deceas~d),-'"
6
)
Applicant,
7
VS.
)
8 BALDWIN EHRET-HILL, INC.,
)
et aI,
9
)
, .
ORDER Al-l>ROVING COMl'ROllISE AND R1!:LEA~E
10
Defendants. )
11
12
The parties to the above-entitled action having filed a Com-
13 promise and Release herein, on June 13, 1969, settling this case ,---;"'= :
14
15
--- for $5,410.50 in addition to all sums which
iousl;" and requestine that it be approved;
may and
have this
been paid prevBoard having
16 considered the entire record, including said Compromise and Release,
17 now finds that it should be approved; and
18
IT IS ORDERED that said ComprOMise and Release is approved.
19
AWARD IS HADE in favor of: HAURINE CLARK
I
20
AGAINST: HARDWARE MUTUAL CASUALTY COMPANY; INDUSTRIAL INDEMNITY;
21
EXCHANGE; INDUSTRIAL INDEl4NITY COMl"ANY; INSURANCE
22
COMfANY OF NORTH AMERICA; PACIFIC EHl--LOYEllS INCURANCE
23
COMPANY; RELI1JlCE INSURANCE COMPANY; THE TRAVELmS
2.
INSURANCE COHPANY; FIBREBOARD CORIJORATION AND l-'LANT
2e
RUBBm ASBESTOS WORKS; FIREHAA' 5 FUND INSURA.~CE COHt'-
26
ANY; ARGONAUT INSURANCE COMl>ANY; ZURICH INSURANCE COHF'
27
ANY; CASUALTY INSURANCE COlHJ ANY OF CALIFORNIA; AHERICA
28
MOTORISTS I:~SUR~'H';E CO}'~ANY; STATE C0I-1PENSATION INSUR-
29
ANCE FUnlJ; LII3J11TY HUTUAL INSURJ'JlCE -.:maJAIIY.
30
-1-
..
1
PAY hELl:: AS FOLLO../~:
2
By: FInE!~J.N' C FmnJ INSURAHCE COHl',\NY
3
To: iLpplicant
.$ 4R. 53
Lr. John Field
200.00
4
J.t torney Steven Roseman, for costs
86.47
Attorney ~tuven Roseman, fur fees
ZOO.OO
5
~l ,035.00
6
l!lJU),;111011I; I~UTU/.L CA!}UALTY cm-a. ArtY
235.00
1
INDUZTRI~ INDBZ::rTY EACHAIIGE
33300
8
lt14.00
9
In~UI~A!l:;[; CQI.!lJiJIY OF NonTlI AliERICA
180.00
10
PACIFI:; EHl'LOYEHS INSUHANCE COMl'f.NY
846.00
11
RELIANCE lU!JtffiANCE emU-'ANY
67 .50
12
TIlE TRAVELERS INSURANCE COHPANY
621.00
13
FIBnsnOARD COHlcrH~Tlml AND l'LANT
RUDBER ASBESTOS vl0RKS
180.00
14 CACUf.LTY INCURhNCE CC~:l-'[J~Y OF CALIFORNIA 39.00
15 hRQCUlloUT INSURAN:E COIIPANY 65.00
16 :lURIC!n nlSUR;J~ct COl<1PANY
90.00
11
Al-:illIClJI HOTORI::;TG IHCURANCE COHIJANY
450.00
18 STATE COHPEUSJ\TIOn IrISURANCE FUND 585.00
19
LIBERTY !ruTUAL II;SUI1ANCE CO!'.l-ANY
2Z0.00
TOTAL
.,'~.~r),1~10 50
26
August 28, 1969.
27
28
29
30
Ho iDrOl;l
WOHK~rr:;N' S COMl'ENSA~ION l.ll-'EALS BOARD
~ALIFORNIA
. ".,
DEPARTMENT UF INDUSl RIAL RELATIONS
DIY1S1C)N ')F lNutJ<;l HIAl ACCIDENTS
WORKMEN/S COMPENSA T10N APPEALS BOARD
STATE OF CALIFORNIA
1
I
I I !:
I
MAURINE CLARK (HIlJOW) DEAN CLARK (DECEA~J::D)
ellU No.
I
Notice of Time
!
and Place of
VS.
Further Hearing
DALD\'1IN ElIHh""T~HILL, INC. j ct al
ALL IS~lJE~
NOTICE TO ALI. PARTIES You ;tre )lcrcby notified that further !1I':,lrillh will hI.' held ill till' abon:-l'lIlitlcJ ;Ktion at
4107 LOS ANGELES STATE Ol-FICE llU ILDING, 107 SOUTII BROAUWA Y LOS AN(jELLS, CALIFORNIA
9 A.H. ALL DAY
~'ORKMEN'S COMPENSATION APPEAl.S BOARD
I
I
L_
\ I I
By
D.lled at: Los Angeles. California NOTE: CONTINUANCES AND FURTHER HEARIN{;S ARE NUT fAVORED,
~I.RVED UY MAll UN I'I'R~ONS ~HOWN
ON THE OHICIAL ADDRESS RECORD
L)~,e:
." By:
~ . . ~ 1 \) ~J.l'
1...... ".. '0I\."~ ..
Copy of application f11(:d Robertc and nalJvl L I,
01 ... wc ... e FO.... 2) LA , .. EV 128
I fO'.... IJltL.Y FO" .. .. 00 L'
3/,~..)/L,6 ,~.: //:.G/('3 s<.:rv<.:d l'arlcer,
Tl:(jlaa~~ &: ~ a).;cr.
t'lcGec,
Peckham &
----. r-.. . _..."f""'.
I 1
'J f
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF INDUSTRIAL ACCIDENTS
WORKMEN's COMPENSAT19N APPEALS STATE OF CALIFORNIA
~ / ) / - r ' Jvd 0"V :J
BOO\)
MAURINE CLARK (WIDOW) DEAN CLARK (DECEASED)
. \
Applicant..__ \
VS.
BALDWIN EHRET-HILL, INC. j AND OTHEn DEFENDANT
AS SET FORTH ON PAGES 1, 2, 3, 4 AND 5 OF ATTACHED AMENDED APPLICATION
INSURANCE COMPANY OF NORTH AMERICA, a corpora-
t10nj AND OTHER DEFENDANTS AS SET FORTH ON
PAGES 1, 2, 3, 4 AND 5 OF ATTACHED AMENDED
APPLICATION
Deft1ldalll..~
Case No. 66LA 292 043
NOTICE OF HEARING
~~You arr hrrcby notinrd dut an 3pplication for compensation has heen filrd Board of thr State of California. You ue further notified that said .application
with thr Workmen's Compensation has been set for huring at
Appe31s
4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADWAY
LOS ANGELES, CALIFORNIA
January 22 & 23, 1969 9:00 A.M. 2 days
and that at said time and place the Workmen's Compen~3tion Appe31s Bo.ud wi1\ proceed to hear and dispose of the said application in the manner prescribed by law.
WORKMEN'S COMPENSATION APPEALS BOARD
By "\':ll 1,. ()' 1:I.;1
REFEREE
Dated at: Los Angeles, California
NOTE: Thc pania art expecccd to ,ubmit all di'putcd iuua for deciSIon n thi, h..rin!!, All witne..es. evidenct. medic.1 rcporn, paywll. and other
proof mu.t be available at the hcar.n!!. CONTINUANCES "'In Ill: GRANTED ONLY UPON A CLEAR SIIOWING OF GOOD CAUSE,
Requests for continu.ncd are tn bc made within I day. !If the date of till' notice. NOTE TO INSUltIf.D EMPLOYERS, Your alltndancc at this hearinl! may lIul be ncce....y. A.k your in.urance company.
SERVED BY MAIL ON PERSONS SHOWN ON THE OFfiCIAL ADDRESS RECORD
Date: 12/4/68
By:.
:.:'
Copy of ap11cat1on filed 2/17/66,
6/26/68 and 9/4/68 served all
amended applications parties.
filed
3/23/66,
'O..... OIA WCAB FO.... ao 1.. ... ,R';V II
I
"LY Fo.... 3~1..'
- -. --'--- - -- ---- -----------
~, ''----'"~: ~--------------------~ GOOD CAUSE APPEAlUNG: The applic:ation herein is 'u.k.cn off c:alcndar.
" " a l l. CA.
Nfl
o.,.rc...c of b41HUial .....cao..
Di..... of Lutuuial Acci.da.tI
Workmen'. CompeDJation Appeals
$cae. of Calilonaia
APPLICATION fOa ADJUDICATION O' CLAIM
(Oeatn Case)
Pl4... ~ ... ~
'~f'Ntl orl,;..l or ,,,. ...., ...
' " ~;N' #lJJr.".,
Board
,
-'-I-e-
c/~ c
AMENDED
66 CASE NO.
Atp 4 \9Sa
APPLICATION
LA 292-043
~ Mn. WI
Mauri ne Cl ark (Wj dow)
I U"-ICAII' I
'APPUCU", . . . . . .11
Dewftey, Caliernia
TI.
Bal4wiA Eh:et-S111, IDC. I,.PLOYUI
cuJBUlpNAL IT IS
(SEE A'l"l'ACHED SHEET 'FOa
ADDITIONAL EMPLOYERS)
1PLOTa.'. ,.,uauc. un'u oa IT'" " IIL, aulll 01
ATTACHED ,......IILY U., " ..II
(SEE
SHEET
FOR
CARRIERS)
P.O. Box 3412~'.~Yla',,,.,,,,,
SaIl Ptallcisco, CailfouIia
at _.-JIy:..la..r_i.o.olJu_s.....p.....l...a...c.~e_sL...., ___________ by the employer Nltained injury arising out
'.I"'U' of
and
in
the
c:oune
of
anpJoyment
to
Ielnl
_ _ _...I.'"'..I..
.:g~_ _ _ _'_I'U_II_ _ _ _ _ _ _ _ _._ _ _ _ _ _ _ _ __
J.nu
IlnTi " PUTt 0' M.Y ....
2. The injury occ:urred .. follo"l: _ _I....DU"-Ih,ga~]...cIa...t.._iloloJoolD~Ou.f_A~sNb~e;;.:s~t_ou.al8_a~D"'d"--loO#-t40.,h.UJ4lulen"".r.-.-..oIfO..c.oI~IJrUIr"l.Q.*W.Ag~Il.l.re-I.,lYl8I~DU,w81H8~.t..a...ll..-c~QHlQt-
,11_'n ,.PLO'..... M " " 0'
M
_________________________
multing
in
death
on
,lUI o,~ --8It-aarkfi'1l~~4h/f__:li_'9!1'_&8~e ..'"'
). Actual earnings at time of injury were: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
'.1'11 .,IILY 0. ".'.LY ",LAI' oa IIO"'LY UTI ..110 .u. . . . 0' IIOUII WOIUI PII Will,
,un, ... The injury c:auted disability .. followl: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ClnCI" LAt' NY 0., _ ". , . , . . . . ., " " All. . . . . . . .11 III.' DATIl 0' AL~ , .0110" IU. TO TIIII
'U., 'H) S. CompawtioD .,.. paid-
-fte-
.$ . -
-
I'.
'- AL-P"- .'
-
, . . . IILY " ' "
""'1'- ,. Medic:al treatment was receind ~ _ _
AU treatment WII furnished by the employer or insurance
c:ompany _
_
otbu
,.0"
ucatmalt .,.
Nfl 01' LAt, UIA'.'."
proTided or paid for
by
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
IT.I' '110' Doc:tOn DOt provided or paid for by anpJoyer or iDIurmc:a c:.ompany .,ho treaced or examined for this injury are: _ _ __
" TWf,."cianf. h2"~ mid burial exoenw. _ _ _ _ TOTAL PAID _ _ _ _ _ __
WandHEulnlpEaFidOIXlE. apUpnlipca:aindcMreedqicu:aalubillh.eXari.og Oandthanua-wLarSdpoefc:ify:D--e'aa.l.&th...&be1e-Jon,be"'ef::iJcD.uX:el::..L.-f..i..B.t."u-Orsi:a:i-l_ap_eD_" _X_ _Co_mp_en_nti_ ou_ac:_c:ru_ed
- - - - - - - - - - - - - - - - - - - - and all other appropriate benenu provided by law.
Hearing requested at __L_O_S_An_9_e_1_e_s_-.. Daced at Los Angeles California. Aug. 26, 1968
IClnl
Ic,nl
lDA'"
Number of witneaa _
Pre-trial .,anced _ _
Estimated time of trial one f u11 d ay""I 'HI
/APPL.CAIIT' ....."UOII
Set now -xx... Set later on .,titteD requat __
LAl'1 OFFICES OF STEVEN nOSEY'JAN 381-311.1...1..__ I&PPI.'UII,'I ,,'o u,
n, 1543 W. Oly.mpj c Ball) ellarc I,os
Ca 1 l.fcrnia .ADoa"I"OTl~IP"O"lIu ....' o'nTO
1\llgeles;
I 90015
ATTACHED SHEET PAGE ONE
EMPLOYER
QUARTER PERIOD OF Et-1PLOY'MENT
DEPENDON ROOFING CO.
3521 N. Cicero Avenue Chicago, Illinois
3/31/40, 6/30/40 9/30/40, 12/3L/40
THERM-O-PROOF INSULATION CO. 4730 Armitage Avenue Chicago, Illinois
12/31/40
DEL E. WEBB CONSTRUCTION CO. , \iHITE , MILLER CONTRS., INC.
Fort Huachuca, Arizona
3/31/41, 6/30/41
O'MALLEY PLASTICS, INC.
P.O. Box 3558 Phoenix, Arizona
3/31/41, 6/30/41
A.N. BORGQUIST
P.O. Box 6134 Phoenix ,Arizona
6/30/41, 9/30/41, 12/31/41
STANDARD ROOFING , SUPPLY CO. P.O. Box 2204 Phoenix, Arizona
6/30/41, 9/30/41 12/31/41
DEL E. WEBB P.O. Box 7588
Phoenix, Arizona
6/30/41
A.O. MILLER CO., INC.
220 Nordina Street Redlands, California
6/30/ 41
C.C. HOORE & CO. Engineers Unit X-1 450 Mission Street San Francisco, California
9/30/41
MC CONKEY, DOCKER' CO., INC. 130-32 W. Madison Street
Phoenix, Arizona
9/30/ 41, 12/31/41
W.A. BECHTEL CO.
1SS Sansome Street San Francisco, California
12/31/41, 3/31/41, 6/30/42
CONSOLIDATED ROOFING ,
CO. P.O. Box 614 Phoenix, Arizona
SUPPLY
12/31/41
MARINE ENGINEERING , SUPPLY
941 E. 2nd Street Los Angeles, California
12/31/41, 3/31/46, 6/30/46, 3/31/47
INSURANCE CARRIER Unkno"rn Unknown STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA STATE OF ARIZONA Unknown
STATE OF ARIZONA PACIFIC EMPLOYERS INS. CO INDUSTRIAL INDEMNITY CO. STATE OF ARIZONA
PACIFIC EMPLOYERS INS. CC
--', OJ T. THORPE, INC. "148 E. 2nd Street
,,' ,":'~s Angeles, California
MUNDET CORK CORPORATION 7101 Tonne11e Avenue North Bergen, New Jersey
12/31/41, 6/30/45, 9/30/45, 12/31/45 3/31/46, 12/31/46 3/31/49, 12/~1/58 3/31/59
6/30/42, 9/30/44 12/31/44, 3/31/45 6/30/45, 6/30/46 9/30/46, 12/31/46 6/30/47, 9/30/47 ~/30/48, 3/31/48 9/30/60, 12/31/47 12/31/60
PACIFIC EMPLOYERS INS. CO
&
AMF.RICAN MOTORISTS INS. COMPANY
AETNA CASUALTY & SURETY INSURANCE COl1PANY
&
PACIFIC ~1PLOYERS INS. CO
THE ASBESTOS & MAGNESIA MATERIALS CO. 119-127 N. Peoria Street Chicago, Illinois
6/30/42,
9/30/42
Unknown
SLATTERY & COMPANY 1726 Market Street Denver, Colorado
12/31/42
Unknown
FULLER-THOMAS CO. 118 S. 5th Ave~ue
Tucson, Arizona
3/31/42, 12/31/42 STATE OF ARIZONA
3/31/47, 6/30/47
12/31/48, 12/31/49
YOUNGS SALES CORP. 1054 Central Industrial Avenue St. Louis, Missouri
9/30/45
Unknown
UNITED CORK COMPANIES CORP. Ft. Central Avenue Kearny, New Jersey
3/31/4~, 12/31/51 3/31/52
LIBF.RTY MUTUAL INS. CO.
PLANT RUBBER & ASBESTOS WKS. 537 Brannon Street San Francisco, California
3/31/46, 12/31/46
SELF INSURED
WARREN & BAILEY CO. 3528 S. Garfield Avenue Los Angeles, California
12/31/46, 3/31/47 9/30/49
Unknown
TECHNICAL SERVICE COMPANY 423 N. 1st Street Albuquerque, New Mexico
6/30/47
Unknown
LEROW COMPANY - 5510 Sheridan Road .
Chicago, Illinois
6/30/48, 9/30/48 12/31/48
Unknown
ASBESTOS ENGINEERING' SUPPLY CO. 12/31/48, 3/31/49
1880 w. Fillmore
6/30/49, 12/31/49
Phoenix, Arizona
STATE OF ARIZONA
REFINERY MAINTENANCE CO., INC. 2500 N. Alameda Street Oompton, California
3/31/49
Unknown
STEARNS ROGER CORP.
660 Bannock Street
C o l o r a d...o -.~.~.--,,--.,
~
~--
6/30/49
STANDARD ACC. INS. CO. RELIANCE INS. CO.
T~ORPE INSULATION CO. 2741 S. Yates Avenue Los Angeles, Califonnia
THOMAS H. HOGAN CO. 1591 Indus Street Santa Ana, California HALL INSULATION CO. 2633 E. 3rd Street Tucson, Arizona KIRCHER, ASBESTOS & RUBBER CO. Inc. Box 6652 Phoenix, Arizona
BARRETT & HOl-1ES 6033 N. 10th,Street Phoenix, Arizona
9/30/49, 12/31/49 6/30/59, 3/31/63 6/30/63, 9/30/63 12/31/63, 6/30/64 9/30/64
9/30/49
3/31/50
12/31/50, 3/31/51 6/30/51, 9/30/51 3/31/52, 6/30/52 9/30/52, 3/31/53 6/30/53, 9/30/53 3/31/54,' 6/30/64 3/31/55, 6/30/55 9/30/55, 3/31/66 6/30/56, 9/30/56, 6/30/57, 9/30/57 3/31/60, 6/30/60
12/31/50
PACIFIC E1-1PLOYERS IN$. CO
&
FIREMAN-S FUND INS. CO. Unknown Unknown STATE OF ARIZONA
STATE OF ARIZONA
ARMSTRONG CORK CO.
Liberty and Charlotte Streets Lancaster, Pa.
9/30/51, 12/31/56
STANDARD ACC. INS. CO. RELIANEE INS. CO. THE TRAVELERS INS. CO.
REECE INSULATION CO. 4563 Valley Boulevard Los Angeles, California
ACCURATE INSULATION CO. 900 S. Cypress La Habra, California
JOHNS ~~ILLE SALES CORP. 22 E. 40th Street New York, N.Y.
COAST INSULATING PRODUCTS 2684 Lacey Street Los Angeles, California
OWENS CORNING FIBERGLAS CORP. P.O. Box 901 Toledo, Ohio
9/30/56, 12/31/56
9/30/56, 12/31/60 3/31/63, 6/30/63
12/31/56, 9/30/57 12/31/57, 9/30/58
12/31/56, 9/30/59, 12/31/60
3/31/57, 12/31/57 9/30/59, 3/31/60 9/30/60, 12/31/60 12/31/61, 3/31/62 6/30/62, 9/30/62 3/31/63, 9/30/63 3/31/64, 6/30/64 9/30/64, 12/31/64
Unknown (moved no address)
CASUALTY INSURANCE CO. OF CALIFORNIA, INC. & STATE COMPENSATION INS. FUND SELF -INSURED
ARGONAUT INSURANCE CO. STATE OF ARIZONA
THE A~NA CAS. & SURETY Ins Co. & THE TRAVELERS INS. CO.
UnJnewn
ATTACHED SHEET PAGE FOUR
JAHAR OLMEN CONSTRUCTION c/o P.O. Box 14322 Houston, Texas
9/30/57, 9/30/58
ORIN A. WILLIAMS , JOHN S. GREEN 3775 N. 36th Avenue Box 11098 Glendale, Arizona
12/31/57
INSULATION' SPECIALTIES INC. Box 3428, Sta. A E1 Paso, Texas
12/31/57
METAL CLAD INSULATION CO. Box 178 Torrance, California
3/31/58, 6/30/58
BOB GRIFFIN ROOFING ,
3/31/58
INSULATION CO., INC.
151 E. 24th Streei
Yuma, Arizona
FIBREBOARD PAPER PRODUCTS CORP. 6/30/58, 9/30/58
1789 Montgomery Street
12/31/58
San Francisco, California
WESTERN ASBESTOS CO. Box 3784 Rincon Annex San Francisco, California PLANT ASBESTOS CO. 1300 64th Street Emeryville, California R.T. DINWIDDIE, INC. 8627 S. Atlantic South Gate, California
3/31/59, 6/30/59
9/30/59, 9/30/60 3/31/61, 6/30/61 6/30/59, 9/30/59'
INSULATION SERVICE INC. Box 4695 Tulsa, OR-lahoma
12/31/59, 6/30/59
LOS ANGELES CORK CO. 4180 E. Washington Los Angeles, California
12/31/60, 9/30/G4
) ACROMRSPT.RONG CONTRACTING' SUPPLY 69//3300//6615,, 162/3/301/6/655 120 N. Lime Street Lancaster, Pa.
UNAFRAX CONSTRUCTION CO. 1242 Abbot Dr. Pittsburgh, Pa.
9/30/61
Unknown _STATE OF ARIZONA
Unknown AETNA CASUALTY & SURETY INS. CO. STATE OF ARIZONA
SELF INSURED STATE COMPENSATION INSURANCE FUND INDUSTRIAL INDEf.1NITY CO. Unknown Unknown ZURICH INSURANCE CO. FIREMAN'S FUND INS. CO. THE TRAVELERS INS. CO. LIBERTY MUTUAL INS. CO.
-,
~
...
-
ATTACHED SHEET PAGE. FIVE.
UNAFRAX CONSTRUCTION CO. 1242 Abbot Dr. Pittsburgh, Pa. <,
9/30/61
INDUSTRIAL SERVICE ,
ENGINEERING CO. OF CALIFORNIA
.Box 16138
Long Beach, California
. - ',."
3/31/63
.'
KITZ~~S PLUMBING , HEATING 6940 Alvarado Rd. Lamesa ,California .
6/30/63
THE ISOTHERM CO." c
60S Williams Bakersfield, California
~
.!
~. THERMAL ENGINEERING INC. Hoffman , So. lOth Street Richmond, California
6/30/64, 12/31/64 12/31/65
BALDWIN, EHRET, BILL, INC. 500 Brevnig Avenue .
Trenton, New Jersey
12/31/65, 1/1966
LIBERTY MUTUAL INS. CO. LIBERTY MUTUAL INS. CO.
INS. CO. OF NO. AMERICA SENTRY INS. CO., a Corp. Unknown
LIBERTY ,MUTUAL INS. CO.
INS. CO. OF NO. AMERICA
,,- -
I,': "
,
-'y
,-
".- "
-' ~ ~
.~.., .' '
,-, <
- , . -:'
. ,": ',' -
: ,;~ I\I SD Department of lnd ustrial '.~el.ti'ol\S .'::; I)1I S1F:.' :_
GOOD CAUSE APPEARING: Thi application herein
Division of Industrial Accideu.t.s " ' , I ,~N(tJ.tS
Workmen's Compensation Appeals 'Bo~rd
is taken off calendar.
State of California
U'UU. WUI
DATI
APPLICATION 'a;R Jl:~ (or. AMEl4Dt~ APPLICATION
FOR ADJUDICATION OF.I'tlAIM
Ple.,e file ,lgfted origifUJl (u.d fix '"0,*'
(Death Case)
66 LA 292-043 CASE NO_--
.N pri.t or tyi' . ."' tiN .adr."e,
M..t1 . M1 n. M1 i.u~/_ _ Ma-u:-r=in::e::::C-:-l_a-r;k;;;;;(;:w:;~;d;;o;;w;.).-___
( ."LItAII"
Dean Clark (Deceased)
13331 Lakewood Boulevard, BrIO
CAPPLICAN", ADoI"'1
Downey, Califo~r=n=i=a~___________
-------------------------------------- 'I~;
, ,.'
VI.
, ,t. ,See attached sheet
--------~----------U--L-O-..-.-, ------------------
i. !; "" ...,c', '.
.I '
See attached sheet
CI.'LO'U'IIIIIUUII" CAIIIII 01 nATl IFIIL'IIIIUUD 01 PlI.II'IIU U'"N,unD'
IT IS CLAIMED THAT:
l~i~I~~D i;'~~;~wr~i) JlC~:,,! Nu;.:.?-07-9443
C,.,LO'II'I ADoUI.,
.11" 1A0DICS10' I"UIAN" CAIIIU, I'
.'.. " .
I. Deceased employee bom _=l=2L.1-=2:LI...:.l~9=_0=_=_7___ while employed as a
. (.An 0' I'N.
Ashestos \iorke""'r_________
COCCU,."ON U "tI, 0' INJUI"
on 1940-1966
at -'V_a=r'-"i=-o=-=u;..:;s~,.;:p;.:l::.;a=c~e:.s:...._ _ _ _ _ _ _ _ _ by the employer sultained injury ariling out
""T" Icny,
of and in the c;ourse of employment to _ _-:l,:u:n:,:g:a.-_ _ _ _ _'._!_'_ _ _ _ _ _ _ _ _ _ _ _ _ _ _, _ _ _ _ __
InUI WMAT 'Aln 0' 'ODT WII' ,IIJUIUI
2.The injury 'occurred as folloWI:
JI.' Inhalation of asbestos and other foreign substances
C"PlA'. w.'" ,.'LOY" WAI DOIII, U
0' III'UI' AIID NOW III'U.Y WAI IIClIYID,
___________________________________ resulting in death on Mar. 4, 1966
CDUI 0' DIATN,
3. Actual earnings at time of injury were: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
C."II W.ULY 01 .0UHL' ,ALAI' 01 NOUILY IAU AND NUIII. . 0' HOURI WOUlD PII WUII,
~. The injury caused disability as followl: _____________________________________
(lPlc,n u n laY or, WOI, Dur '0 'H'I '.JUI, AND IIIIIINIIII AND 11101". DUll 0, ALL "liDO' 0" DUI TO 'HII 'N'UI"
f. Compensation w~ pai~ "-D.C... $_ _ _ _ _ __
$------- ,,,., '"0'
,'OTU PAID'
,wruLY UU'
CDU' 0' tAn PUII'""
. 6. Medical treatm"nt was received ~e5...-- __________ All treatment was furnished by the employer or insurance
0' nu,
'110' lOAn un tlU,.,II',
company _ _' "_'___ other treatment was provided or paid for ~y
(fUI
'.01
Doctors not p'rovided or paid for by employer or insur:ance company, who treated or examined for this injury are:
St. Francis Hospital 3630 ImpMial 1Iighway, r.JynwoQ~CalifQrni~
InUI ...... AIID ADD. . . . . . 0' lueN OOC'." AIID "'11" 0, HO.,lfALi '0 WilleN IUCH DOC'OIi ADtilTTlD .1I,unD,
7. Defendants have paid burial expense. _ _ _ _ _ TOTAL PAID ________
("'"
1110.
I. The employee left surviving him the following dependents:
NAMI!.
None
DATE OF BIRTH (if under 21)
RELATIONSHIP TO THE EMPLOYEE
ADDRESS
WHEREFOllEt.applicant requests a hearing and an a.ward of: Death bene6t..-lL Burial expen_ JL Compensation
and unpai~ Unpaid Medic:al bill, X Other_ Specify: _ _ _ __
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and all other appropriate benefits provided by law.
:t R t f - t:!1t/'A;:.' k.~" Hearing requested
LO& A::19Q1oa-, Daud at -LQs:;-Anqe-l9B.--. Californi:a. -1-une-.!r.=M,...-,;I;-
fC"Y'
fCI'''. I
,
Number of witnesses - - Pre-trial wanted - - - -
r~_tl'matedt'ime 0 ftr'saLI._ _ _ _ _ _ _ _ _"_,._. _11_10,
'"./ t :"L../)"~/"~ ,,,/
fY
,/AI? ((,1, (:;-
I~' "~~/.-/::A
. . . -_. _._. --:-
~t now ___ ; ~t later on written request _ _
Jr L1\\ OFFICE~) OF '~rrr<>l~I)'G'W oJ _ ______________
1543 w. Olympic"'Nou'l.'cva"i-[cl'
Los Anqe les--- a-liPftr.'1tl-et-IID.'IS AND TILl'""'"' HUM.'. Of AlTOtl'M,.,.
accrued
I ...
APPLICA TION '
(Death
(jJ! FILE SIGNED OIUGINAL AND SIX COPIES
(pLEASE PRINT OR nPE NAMES AND, ADDRESSES) t,;; /'/ ..<, ,
""I: :
,"-' ~t . -
,., ..., .~' ~
,,<1' ' : .
V"
MAURINE CLARK (Wid.} ......' - .... ~ ,.,t.IC' .-. _... .
DEAN CLARK (Deceased)
....'""~~.............,---.~~~-'.~ .. ~~'
';';t:f~ .--------------,,.---------
Case)
.~' :
"~""' PI:' '\:'
.11>...
"
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,I' l,t!JI!\,..,.
,t
",;,
___
CASE No.
/) (/''7 ,...
;~
.' I ~
~
13331 Lakewood BOl!levard, B-lO AP'~'CAIIT" ADD.II.
,,--DowAey'r ;C~a.l".,i",f;{"o~:r:~Il~l.""iiia---------_
Dean Clark (Dec.) 88# 327-07-9443
'. ',;~t!~!;
, !' .'
'.'&.0"1 .r .... BALDWIN EHRET-HILL, INC. " ,., ....-------------~---'------ ..... ~
Contracting Division, Post Office Box number 34126
n'~TII" ADDIIi.
". ~. ;," l ....:t,;.~ ,1- -
:1~;~:.:
San Francisco, California
'.rLDTlI" ,U......C.&..C..AII.IL'IYI 0U1."I.A..T..I..""UIUII,O I01
.!;~~
\. '" -2' .
v/
621 8o~th Virgil ~venue
u ....ce C.....II. ADDU. .
~os ~ngeles, Ca1if~o~r=n=i==a___________
u ,,'.:Z~., 1. Ie is allcged that-Dun Cl~.1p.!.Seased)
--<111...2..r.L./..2.u/-'1~9e:.:O.7L___ _ _ _ _ _ _ _ _, while employed as
. ' < .'" -
- ....1 Dr I.'~'" -
,1-, .:~$:"
t
,:,. r
.
_ _ _,I;Aus:u.b..e...sa.lot~OUilSL...1WU..o..r~kDo.liie..r.._ _ _..;;..-_ _ on J~_to.
19_6.6.... at
various
place, California.
:i ,?:~l~ :f.-. by _......'".,.....B....8.;oD...lCd..C.w..".A..i."oOu..;A::T-..IY.b.l..I.I.rI...De' t,t.u-U::I;Y.H~i...l..l...,.--"I...o~c.....'--_____'ATsIu0st' a,.iJUnIeYlu.J~~yatbi~g. t~l~'-~n~' i~C~IT.~~ctu'i:~ em;p.~l'o(Jy~'e.nt { ~
! ."f;,' ,
,
..... 0' 1._.1
I.:..: t')':' CO _ _..U..\I.IJNGWDolL-_ _ _ _ _ _ _:.....-._ __.. as follow.: _ ....I...N...H...A...L..A....T.._I.xO.N._Q~F~A..S.~Bo.rr.;.S.....T.OL.X,lIS,........A..N...D..._O:z...T...H.....=E...,R.....
.< I: .. ,~~,
~ _
,..1
; ~.~~ '~r- ~
'UnD'IOOY
II,UI. NOW ,.JUIY WAI IICIIYID
_ _ _..r..:..sQ...U.__IoIo:G~NI.-..aiOS.u...U.B..S~.T...A.a.ilNC_E..S.&..-_ _ _ _ _ _ _ resulting in death on March 4. 1966
DATI 0' DUTN
! :'. 2. Employee" a,tual caming. at time o injury $,_.?..._ _-'lat_
The basis of pay wa,~'_ _ _ _ _ _ _ __
_-:-. ;.
. .:;
WII.OI .O.TII
~~}
".
,,'
l~:: .~-
$ - - - - - ';'" ,. Wu compensation paidl
.N.....O .. '-_ $ - - - -
"
,~~.} ".
Yo.o
TOTAL ,.10
...IIILT IAn
D..TI 0' un ."'.UT
~ ~~~ : ..
. '."
l' -r ,'_;S.~I
Was medical trcatment tcccived1 YES
.... -' ' .
'I"
DATI U" IICIIVID
Was .11 medical treatmene provided by employcr or insurancc c:oml?any~
~ ,;:j:I: ~~. If no, state who provided it. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _'II'_ _ _ _.0__
ST.
/ Lynwood
HOSRITAI.. 3630 QmVBHY r~IS
Imper~~hway,
..uo "loTI .A.n A.D .OD. . . .IS 0' . u DOCIO.' WHO TIIATID DI ......UNCD '0. THII .NJUIY
.' - , . f . '
California
S. Has burial expense been paid? _ __
,It
$_ _ _ _ Who paid it? _ _ _ _ _ _ _ _ _ _ _ _ __
10
,,:, , f. Ttu. appUcacion it filed for:
t! ::h' '.J~th bcnent",_XA-__ Burial expenlllll.~_ _ _ Compensation accrued and Wlpaid _ _ _ _ _._ _ _ _ _ _ _ _ _ __
~
,,_" Jr'
Other_ _ _ _ Specify: _ _ _ _._ _ _ _ _ _ _ _ _ _ _ _ _ _~
7. The employee 1.ic ."rviving him the following dependcnu:
(}';'; AGE
NAME
. . ClpUNDttII21)
NOR 11.{(u.~ ~ 4'~
/';..<_ _ __
RELATIONSHIP TO THE EMPLOYEE
_ " NONS lJ...-:
--------
ADDRESS
IMPORTANT-If any applicant is under 21 years of age. it will he nccc~\.Iry to file Pditioll for Appointment o( Gu:mJian ad Litem. Forms (or this purpose may be obtained at the ofii~e oi the InJu$tri,I\ Al.:cidcnt Commission.
WHEREFORE. IIpplic'lInl rrqueJis /I h~lIrin8 IInJ lin IIwarJ for ,,/I ai'l'rop,ialc' be'neftls he is mlillt-J 10 by laUl.
Dated at Los Ange les . C.a\iiorniat.\."l rch 22, 1966
,. - )
. ~ ~-<LA'W .OF<F ~'-L'::/~--t.Lf./ He.lring requested at Los Angeles
:2!-
I Enimated timet of trial___________ ~/
~PlcaMaetnow--isetl:lteronwrittenreque$(--.
CITY
,
DATI
_ _ . .. ~"ATu.i
5" op' S'f..EVE~f'ltbSEMAN IAeT.O",." . A'.~IC '.
..:::.:.~-"'-"--~:;.,;;,.,--.;,~::..::=-=---01 .1'.'I~ TATlV'
1621 w. 9th St.,
(Du 5-3071)
j
I ~
I",
-:-:
APPLICATION
FILE SIGNED ORIGINAL AND SIX COPIES
.(PlWE PRIIIT OR TYPE NAMlS AJU). ADDRfSSES)
" ..
'~6 LA L9204 "s.
CASE No.
Dean Clark ,/ APPUCAII' Social Security No 327-07-9443
13331 Lakewood Boulevard
A,.LlCUT'. AOOlnl
Downey, California
Telephone No._ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
,1
;1
~'I''''
~~J;
~!
ri""
1--'
~.~
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Baldwin -Ehret Hill, Inc.
I.P~YlI
Unknown
C.~"'IIIIIU"IICI CUIIIII 01 l u n If "LoP.IIIIUln 01 PIIIIIIIIIU III'.IUI"
Contracting Div., P.o. Box 34126
'11'1.0"1'. AOOI. .I
San Francisco, California
'lI'UllAIICI CAli'"" ADDlcal
1. It iI aUeged thac.....Q!la:;nu.....C;:::..c.la::.a.r.k.~._ _._ _ _ _. J.2L2/1'.:107 , while employ\.-u 00_...;;1;;,.;;9;,...4:,.;0;._-_1,;;;.9.;.,.6..:;,,..;;,6_ 19_
cr .... Of Ilno,,,
DATI 0. IIUII
DATI 0' IIiJUIY
.. a.a_8_s!.ilbt.:!eii!.Jslit~t~o~s~W~Q""ru;k~.e..r.._ _ _ _._ _ _ _ at
various places, including San, California,
OCCU.ATlOII AT Till' Of 'IIJUI'
CITY. lOWII 01 'UC, WHU. IIUUU occunco F r a nc i s
by
Baldwin-Ehret Hjll,
Im: *________
:
sustained
I
(.,,;
lDJurY 2rising out of
. (
and
l' ..
occurring
iD
the
, '(
cour
~ I. . '
of th,
employment.
1.11. 0' 'II~TlI
Lun~
ITA" _HAY 'Aln 0' aOD' WII' IIIJUIlD AIID IUlnllUUT I . .UUI
DO'" leba] ation of asbestos and other foreign substa~~c::-:e;:-s=--_ _ _ _ _ _ _ _ _ __
1I'1oA11i WHAT 'IIPLOna WAI
AT TIll' . r IlIlua, All. HOW ,IIJUIY WAt UCIIVlD
2. Act~l carDinp at time of injury ~$_ _ _ _ _per'_ _ _ _ _ _ The balis of pay was: _ _ _ _ _ _ _ _ _ _ _ _ _ __
WIII.IIIOllfll
.TA" ,AY ''''011
.1 IIOUILY bU. NOU. . A DA' All' DATI A Will
l. Periodl diaabled for work:
XatQX'ERittQntly and since .January. 19fi6u'--__________
"lei" ""1111111. AliI 1110111. DAnl 0' ALL .U,ODI 0" WOU DUE TO TMII INJUn
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _._ _ _ _ Date returned to work.
4. W.. compensation paid? ,..
No
10
$
TOTAL 'A'O
$,---wun, lUI
------------------- DATC 0' LAtT .AYIICNT
"I .,~.' i
Have you received Wlemployment or unemployment ~ompcnsation Jisability benefits since the date of injury? _
i
NO
.I
s. Wu medical treatment received? Yes
State J:Jtc last received: currently
'"
NO.
w.. all treatmeDt provided by die employer or insurance company?
I"
no
110
Ii not, .tate who provided it. _,_ _ _ _ _ _ _ _ _ _ _ _._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
!
~i
'I
.:' il :, .j .. ,,")
I
~'i
ii!it
-
AI. uate nama and addmsn of all doctor. who treated or examined for this injury. _St ! .. Fr~ncis H~!.~_a_l_ _
---------------------_.- ---_ __ _-_._. .. ...
6. This applicatioD it 1iled because of disagreement regarding liability for:
__._-_. ~----------
Temporary diaability yoe Permanent diubility ye sPropcr Compt"ns:uion Rolll.:. ___ yes
Self-procured medical~cOlti yes Litigation costs _ya.a_ Medical tnatment. ~ . Other: yesSpcc:;fy: _ i mm(td.ia.t.f'_...me.d.ic.al_.t.r.ea tme.nt.. q)1g,_!?_\!rgCl:y __ _ ____ ._______
7. Have you ever had a case {or another injury be{on: the California C<lIllmission? _ - - ._ _ ~ __ .____ . ______
WHEREfOIW. ",puc",,1 rtqJltJls fI htflring find flWfI,J fur fill flNmlpriflll' bflll'jill pruviJed by 1.11/'.
Los Angeles
Hearing requested at
-- - ...._- _. en,
Estimated time of tri~JL-._ _ _ _ _.__ . - .-- .. - - - . Please set DOW_ _ i set later on written reque~t___.
Dated at. Los l\Il.<.Je los _ _, Cali (orniol, Fcbru<ll:-y 15, 19
_ '-:(.:-' -J~~., ' .,
_.i..\ \ \\ H ,.. \-~~!?--~. :~': CIT'.
DATI
hi tl , I \ , ! ""lICA''''. ,,~,
l
q
I ~'(
LAW OFPIC8.S ..oLSm~LEJ,,:-I-:c-'R~Q~S~E~-,MAN,:-=-:::.!-_ _ _ _ __
Ar~LIUMT'. ATlalNn aM ll,aULN'ATlV'
lG21
Calif ornia es, th 1 J q
',I'
La,> A,orrr>
AggO'" "ND TtLl'"OM[ MU U OJ Ano.u, o "IUIIIIUIVI
,
.
- : ,,:.!.. : "
,:~,~~~:: .
.>
-----_._._---
...~
, ,,~~,.~(~:~ -::~F' "
;. ~.:,1
I'.
:. ,< [.
.,"..
-------------.----------------------------------------------J~
~~.~.~~------....----------------~~--.------~~----.-~'1.,;-'. -------------------------------------~--------------------------------------------------------.-~-.f/-" ~~~
. l-~:<-;;.:~~,~~l; .
. ~"':-. ~
, i,.l: ~}~'"=-
- ..... .._.... _------_.--.------- ---~~- -~.- '".--. .--.--~----.--- . --~ ---------"1'~
----f-t~---- -'-'-~ ~
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~~
--....-----
-?"~.::-- - ----.- '. ->.
.,.''''''~~
,,',.,
~
-
-----~----.- - - - - - --~--'.
~ ~,#~ ~~:- -
....., ...
..
'-.?<~~:~'.;:L--- -
- .-~~~
1 .~ -- I
._,
.~ i
'-"'''"~
~~<; .:\;;.~:!i.:.~....... ...;;..~;,:,,,;:~~;~~'~*1-4-' .......'~~...w....._,~...~ _-_-...____-..,.~~"*:.........__.__ ' ..... ~~~~..:-,
----~.... ~
I
r' ~
'.r...,Q.t.t1.c".e.a .,
. "
16el. West lf1IIth "ItzNt
r.oa Impl.., ~
" a.nlll
Mnm7 23, 1961
I
/
lD l'el4 to 7QVr lettera at l'wbIlIIJr7 16 &d4neaecl to w aDd our '.1141&'rJ';
~1zoaI ~ aDd ~ CoI"pn.tlem, _ w1ah to adv1H tb&t our 1101"_ _', CCiipiDRt1oIl1DauraJlCe cazT1er ... staMard Acc14eJlt WUl'aDCe
~ 1a 1951 &DI1!be 1'J:awl.en IMuruce ec.p. 1a 1956 ad 1961.
I ,~t.. .. _~ .... "
"-
Va] 1.". :a. JIottetll
t.1Il'UCe ~fP
--
..-~ '. !- ....
. __ .....- - -:v'-'-."_
- _;~.
"
1 ,
I STEVEN ROSEMAN ANTHONY J. BRADISSE HERMAN FEUERSTEJN
Ii JAMES J .WALSH
l.4wODis
STEVEN ROSEMAN
'821 WEST NINTH STREET LOS ANGELES a00115
February 16, 1967
TJ:LK,,"ONK. DUNKIRK 15-3071
Armstrong Contracting &Supply Corporation
120 North Lime Street Lancaster, Pennsylvania
Re: Dean Clark (Decedent); Maurine Clark (Widow) 66 LA 292-043
Gentlemen:
We are the attorneys for the widow of Dean Clark. We are representing Mrs. Clark before the Workmen's Compensation Appeals Board in connection with a claim which alleges exposure to foreign substances, such as asbestos, during the period of 1940 through 1965. Social Security records indicate that Mr. Dean Clark was employed by your company during the following period or periods:
The second quarter of 1961.
Would you kindly furnish us with the name of your Workmen's Compensation insurance carrier for the above-noted period or periods?
Thank you.
SR: 1m
.
>. ;
, t J ;'
... ;
STEVEN ROSEMAN ANTHONY J. BRADISSE HERMAN FEUERSTEJN JAMES J .WALSH
1821
l.4tuO~
STEVEN ROSEMAN
ATTORHEYS AND COUNaELO"a AT LAW WEST NINTH STREET LOS ANGELES
aoollS
February 16, 1967
./~
~'CJ
TaUJOHONa.
DUNKI"K 11.3071
Armstrong Cork Company Liberty and Charlotte Streets Lancaster, Pennsylvania
Re: Dean' Clark (Decedent); Maurine Clark (Widow) 66 LA 292-043
Gentlemen: We are the attorneys for the widow of Dean Clark.
We are representing Mrs. Clark before the Workmen's Compensation Appeals Board in connection with a claim which alleges exposure to foreign substances, such as asbestos, during the period of 1940 through 1965. Social Security records indicate that Mr. Dean Clark was employed by your company during the following period or periods:
The second and third quarters of 1951, the last quarter of 1956.
Would you kindly furnish us with the name of your Workmen's Compensation insurance carrier for the above-noted period or periods?
Thank you.
SR:lm
~'I