Document v6V7BJp8mNDGZJmxn9NyvwBvY
FILE NAME: Plant Insulation Company (PIC) DATE: 1963 Aug 23 DOC#: PIC006 DOCUMENT DESCRIPTION: Worker's Compensation Claim
*TATt O CjtLlFOKNIA IKDU5TIMAL ACCIDENT COMM15S10N
AMENDED
APPLICATIO N
1* nCNFD OWOfNAL ANIJ SIX COMET (PLEASE PRIHI OR TYPE NAMES AND ADDRESSES)
CASE N O .
6 2 OAK OlOO
_ l A U L .* r .A,,QUEISt?H/VH.
JJJ9_ 1\q a lyn_ JPrrly e j C oncord. Calif o r n ia
SckmIScCvnty No. ,,,,i497'*Q5",9^-
PLANT RUBBER ASBESTOS C O .. ET AL
J*75 Pfranran Strgc_t_
San F ran cisco * C a lifo rn ia
EMPLOYERSOHOUf. ET AL ******' **<*****
1050 Ruas Building (> *. * MMIM
San F ran cisco, C a lifo r n ia
t Pavi1 J^_Gre13cha r >*<
_ ? /3 >/0 2 , u ****
lK,, _ K. r . P r i o r t o J u n e ,, _ 6 3 If MJ*
kgA aabeat00 A 1na111ation worjjpr ;_____ Various place
!<It **II* **#*<
Him *<*<
Cf) .
ACC 0 t t f l c h c d H a b
....
t _Itf tuifiinr4 injury iriun| mil al and tn iHi COU/*Cof tba employment. il follavi
*r itnafri
e x p o s u r e t o h a r m fu l d u s t s an d m a t e r i a l n_____________________________________ ..njlcinCb> /uia tan wmnnm*
_pulm onary d i s a b i l i t y and pneumon o eo n lo s 1a lt* **
______ >*'>
______________ _______________
oee A ttached ) l3 t
*** <***"< mm. am
tit *>milML lllft *****
no tim e lo o t
* ## I*tV* Ml*
tiM. muilutfl'i iniufin ctmet 00 J m of injory. r____________
itu#i at#ai#i*i*i#
4, W compintitno paidfTM,..?__ __ ___ ___ to
I . !W m n g a int of in ju rj
__________ (g)
0|> *1 Tl|(
TKr !*< of py tfitt
11 V
h ou rly It M. M*O. *
i. V j mrJit 1 uinmint nffdfj t _
t
_ (app 1leant)____
Y e a ____ Wbo furni,bed CMmen*I__ J.m--IflO X A f
__ __ <.mmmmucl.at mmm.**% muai
ES.1sP B M- t>
7. H im ip filiritu M aa filed to d tifr in in t
for:
Trttipaii')'Jiililifj'..X?P l>. Primincat 4iaililitjXA,.,
t(4 att
la mu
t . Lilijt*0O
1.
__________ _
C. MediciI - --.... .
-- *t Medical coal-- X C ? -- --. < a*tt
Uttml iMHIt tlMImm /tt*'"*
VlfCanfOAE. U h requntrJ tbt 4 time plscr hr ici fa* lv*mf W tk ft --
bfofci u"J** f/w VPttkmCn'i Com brnuftan l^u/, t/
9
n cvf ,1 _..........O a k la n d
, r,
b<
- *>
/-........Au r u s t . 2 3 ,.,,19.63____
HtSh| itn*iwd --.--Q a k l an d ------ ------ _ - Numlwt of a-iiB------------------------~~---------- - -
Ei*am ii*d tame of trial ...__ O f l C " h f l l f
^
y
//
//. .!
SMITH, PARRISH. PADUCK.-J&...CLANCX__ _
31^ F inancial C en ter n u lld ln c O a k l a n d 1 2 , C a l i f o r n i a ________
M--<
***>!< * **<Ml 1
*
EXHIBIT
001
4 I m --%,
*
*
f~
Ati --- . . . . -l\ .L
employers
1 ,, plant Rubber & Asbestos Co, 475 Brannan Street San Francisco,, California
2. Western Asbestos Company Box 3 7 W Rincon Annex San Francisco, California
3* Cork Insulation Co., Inc, 155 Hast 44th street New York, New York
4* plant Asbestos Co* 1300 - 64th Street Emeryville, California
5. J- Thorp & Son, Inc. 1351 O a c m Avenue Erneryv11V 9 Califernia
6. Fiberglass Engineering P.0, Box 89 Santa Clara, California
7. Owens Coming Fiberglass P.0. Box 09 S.*rta C1ara, Callfo;w,l 1
3 * M * R, Carpenfcer 907 Front Street Sacramento, California
9. Parker Insu latlon Cont racting & Supply Corporation 151 Bayehore Blvd. San Francisco, California
10.Armstrong Contracting & Supply Company 304 Shaw Road 3an Franciseo, Ca11 fornia
11.Parker Fa Ills Insulation C s* 1074 OrXeans Street Dallas 10, Texas
12*Armstrong Cork Co. 304 Shaw Road San Francisco, California
}3.Trlangle Insulation, Inc. Route 7 Paducah, Kean.
PERIODS 19^2 to 1947; I9l>9, 1961 1946 to 1951: 1959 and 1961 19^6 and 19^7 19^9, 1951; 1961 end 1962 1951; 395 to 1961 1 9 5 4 , 1956, 1962 end j?63 195^-1956; 1950 and 1959 1955; 1962 1951, 1961
1961
1951 and 1962 1952
INSURANCE CARRIERS
Employers Cro.up 1050 Suns Building San Francisco, California
State Compensation Insurance Fund 5^5 Golden Gate Avenue San FranciacO, CaIlforn1a
Aetna Casvia11y 4 Sure iy Co. 1339 Broadway Oakland, Calif0rn1a
EMPLOYERS Plant Rubber i Asbestos Co, end J. Thorpe & Sons , Inc .
Western Asbestos Co. and m . 1?. Carpenter -
Fiberglass Knr.inccriug 4 Supply
0)
002
INS UBANCECAKH.fi-: KS
American Employers Insurance Co* 510 Buss Building San Francisco, California
Travelers Insurance Company 195^ Webster Street Oakland, Ca11fomi a
Pacific Employers Insurance Co* 2*1*1 Pine Street San Francisco, California
Employers Liability Assurance Corp. Russ Building San Francisco, California
ATTORNEYS
Hanna & Brophy San Pablo
Oakland, California
Sedgwick, Betert> Horan t c Arnold IOO Bush Street San Francisco, California
EMPLOYERi Parker Insulation Contracting & Supply and Parker Fa11Is Insu lation Armstrong Contracting & Supply Co. and Armstrong Cork
J . Thorpe & Sono (1951)
J, Thorpe h Sons and Plant Asbestos Co.
(p r o o f o p SERVICE BY M A IL-1013a, 2015.5 C.c.p.)
STATE OF CALIFORNIA COUNTY CO ALAMEDA )
I am a resident of the United States and a resident of the afore said county; I am over the age of eighteen years and not a party to the within above action; , my business address is:
315 Financial Center Building, Oakland 12, California
On August 23, 1963, I served the within AMENDED APPLICATION on the various parties in said action, by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid, in the United States post office mall box at Oakland, California, addressed as follows:
Plant Rubber & Asbestos Co., *175 Brannan Street, San Francisco, Cal. Western Asbestos Co., Box 3784 Rincon Annex, San Francisco, Cal. Cork Insulation Co., Inc., 155 East 44th Street, New York, Mew York Plant Asbestos Co., 1300 - 64th Street, Emeryville, California J. Thorpe & Son, 1351 Ocean Avenue, Emeryville, California Fiberglass Engineering & Supply, Co., P.O. Box 8 9 , Santa Clara, Cal. Owens Corning Fiberglass, P.O. Box 8 9 , Santa Clara, California M. R. Carpenter, 907 Front Street, Sacramento, California Parker Insulation Contracting & Supply Corp., 151 Bayshore Blvd.
San Francisco, Cal. Armstrong Contracting & Supply Co., 304 Shaw Road, San Francisco,
California Parker Fallls Insulation Co., 1074 Orleans Street, Dallas, Texas Armstrong Cork Co., 304 Shaw Road, San Francisco, California Triangle Asbestos & Insulation Inc., Route 7, Paducah, Kenn. Employers Croup, 1050 Russ Building, San Francisco, California State Compensation Insurance Fund, 525 Golden Gate Avenue, San
Francisco, California Aetna Casualty & Surety Co., 1330 Broadway, Oakland, California American Employers Insurance Co., 510 Russ Building, san Francisco
California Travelers Insurance Company, 1956 Webster St., Oakland, California Pacific Employers Insurance Co., 244 Pine Street, San Francisco, C a . Employers Liability Assurance Corp., Russ Building, San Francisco,
California Hanna & Brophy, 1540 San Pablo, Oakland, California Sedgwick, Detert, Moran & Arnold, 100 Bush Street, Son Francisco,
California
I certify under penalty of perjury,* that the foregoing is true and correct.
Executed on August 23, 1963, at Oakland, California , //
Sister :J
c
___
/
*The proof of service by mail form, being signed under penalty of
perjury, does not require notarization.
004