-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Qc9SVQQ11ZLmWP4MZWbjzxZ5UHnKNEyaolwaiPB2WdZsn3exMm2dICLyU1qFSb+P YDyNR0nP65H2x4Rnvaf1LA== 0001209191-06-048773.txt : 20060905 0001209191-06-048773.hdr.sgml : 20060904 20060905155150 ACCESSION NUMBER: 0001209191-06-048773 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20060901 FILED AS OF DATE: 20060905 DATE AS OF CHANGE: 20060905 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMERISAFE INC CENTRAL INDEX KEY: 0001018979 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 752069407 STATE OF INCORPORATION: TX FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 BUSINESS PHONE: 337-463-9052 MAIL ADDRESS: STREET 1: 2301 HIGHWAY 190 WEST CITY: DERIDDER STATE: LA ZIP: 70634 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NARIGON DAVID O CENTRAL INDEX KEY: 0001199862 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-12251 FILM NUMBER: 061074023 BUSINESS ADDRESS: STREET 1: P O BOX712 CITY: DES MOINES STATE: IA ZIP: 50303-0712 BUSINESS PHONE: 5152802658 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2006-09-01 0 0001018979 AMERISAFE INC AMSF 0001199862 NARIGON DAVID O 2301 HIGHWAY 190 WEST DERIDDER LA 70634 0 1 0 0 Executive Vice President Employee Stock Option (right to buy) 10.94 2006-09-01 4 A 0 50000 0.00 A 2016-09-01 Common stock, per share par value $.01 50000 50000 D The option vests in five equal installments on November 17, 2006, 2007, 2008, 2009 and 2010. /s/ Dayna M. Edwards, signing for David O. Narigon. 2006-09-05 -----END PRIVACY-ENHANCED MESSAGE-----