Document rxm3QkyqN0K1Gyjp9VYz69y47

5 PLAINTIFF'S 2 EXHIBIT ? Qipaos STATE OF CONNECTICUT) ) SS. Bridgeport COUNTV OF FAIRFIELD ) Exhibit # \9as-\ 'vr* Case # U.S. DISTRICT COURT EASTERN DISTRICT OF TENNESSEE CERTIFICATION THIS IS TO CERTIFY that the attached is a true and accurate copy of the Agreement to Compromise, Petition to Compromise and Order, and radiographic report from B. M. Parmelee, M.D. from the records of the Office of Workmen's Compensation Commission, State of Connecticut, Fourth District, in the case of: Stanley Dudzinski vs. Raybestos Company, now Raybestos-Manhattan, Inc. and The American Surety Company of New York; The Hartford Accident & Indemnity Company; and Employers' Liability Assurance Corporation, Ltd. 1 this ^ ^T~C\r A Gi ven under my hand and sea day o u G-uJ f y..o1978. o JOHN A. ARCUDI,_ workmen's Compensation Commissioner fourth District PLAINTIFF'S EXHIBIT STANLEY DUDZINSH Claimant VB. RAYBKSTOS COMPANY, now RAYBESTOS-MANHATTAN, INC. Employer CCRAMi COMPENSATION COMMISSIONER, and THE AMERICAN SURETY COMPANY OF NEW YORK, FOURTH CONGREJ SIONAL DISTRK THE HARTFORD ACCIDENT * INDEMNITY COMPANY and EMPLOYERS LIABILITY ASSURANCE CORPORATION, LTD. Insurer* BRIDGEPORT, CONNECTICUT Respondents. (Ootober 19 AGREEMENT TO CQMPRCMISK. PETITION TO COMPROMISE AND ORDER. WHEREAS, on or about the 16th day of April, 1938, and for a number of years prior thereto, at intermittent periods, 1 olaimant, Stanley Du&flinald of Bridgeport, Connecticut, was an employee of the Raybestos Company, now the Raybestos-Mahhattanj Ino. of Bridgeport, Connecticut) and WHEREAS, the said Employee and Enployer had aooepted were at all times herein mentioned subjeot to Part B of the Wo men1* Compensation Aot of the State of Conneoticut as amended, WUV AU1^AU|VA' jjftU AUO T A - - .A> !/ vvumv* ^ ^ during whioh said Claimant was esployad with the above named 2 surer*, all of whioh said companies do business and art duly authorised to take suoh risks In this Statt) and WHEREAS, the Claimant claims that on or about the 16th day of April, 1938, ho axhibitad symptoms and waa found to ba Buffering from asbeatosls and pnaumooonioai*) and further claim that such constitute an occupational die ease which arose out of and in the oourse of his employment with the said Employer) and further oleins that said disease ia oampensablaj and further ol&ims that he has been disabled from all work slnoe said April 16, 1938f and further olalms that he will be disabled in the fu* ture, all of which said claims each and all of said Respondents deny) and WHEREAS, it is the desire of the Claimant and the Re spondents and eaoh of them to rcaoh an amicable adjustment of t] above disputed olaim to the end that further litigation be endei and that doubtful and disputed claims bs rendered oertainj THIS IS TO CERTIFY THAT I, the Claimant, have agreed receive from the above named Respondents the full sum of twenty five hundred dollars ($2,500), in full aooord and satisfaction the above disputed ol&imj AND TO FURTHER CERTIFY THAT, in consideration of aald sum so paid, I, the Claimant, do hereby remise, release and for ever di a charge the Employer and the Insurers, Respondents, fros all claims for compensation benefits, whether for compensation any form payable to me under said Aot or for surgical, medioal hospital benefits payable on behalf, and whether said claim already arisen or might arise by reason of the aforesaid olaim oooupational disease) AND TC FURTHER CERTIFT THAT I bar* no wife or children, and that I hare parent* whose names art michall dudziesxi and anna DJDZIN3KI , who lire in the Town of . Dziembrov, - in Poland, whleh parent* are In way dependant upon we within the provisions of the Workmen*# C pensation Act, which fact* shall be found and determined by tb Compensation Commissioner in accepting and approving this sett meat and compromise} Ai;D to FURTHER CERTIFY THAT We, the Claimant and the Re spondents, hereby submit this written Agreement to the Compens; tion Commissioner of the Fourth Congressional District, and re spectfully aslc that said Agreement may be approved with the fo of a full and final award. IN WITNESS WHEREOF, We have hereunto set our hands the di end date first above written. CLALAl*! RATBESTOS CG4PANY, now THE RATHE! MANHATTAN, INCORPORATED, euplcti:] by -ittAl-Attorsey THE ALliRICAIi SURETY COUPAHY C*F NEW YORK *- % by' : its Attorney ~"7~" THE HARTFORD ACClDfchT'iD'lHIE!Ji CC'.iPAllI . f) by ' [) its Ropresentatlve APPROVED* Compensation Commissioner of the Fourth Congressional District* MMUMUi A- CO CoO H0tO r*-*t sis W9 H9 1* M OO *4 fl Wfl 8 f X*4 Nto xc OC +d O ^5 h> 6- *VuHHt 9duO aP X>> O *0H d 4POl>- -OtfH.l f-jt OP U XO C*rj X C>>b<*4 *i-H4 fe* fu