0001209191-21-052979.txt : 20210823
0001209191-21-052979.hdr.sgml : 20210823
20210823172651
ACCESSION NUMBER: 0001209191-21-052979
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210819
FILED AS OF DATE: 20210823
DATE AS OF CHANGE: 20210823
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GARCIA PHILIP A
CENTRAL INDEX KEY: 0001177114
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-12251
FILM NUMBER: 211197838
MAIL ADDRESS:
STREET 1: 100 ERIE INSURANCE PL
CITY: ERIE
STATE: PA
ZIP: 16530
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-08-19
0
0001018979
AMERISAFE INC
AMSF
0001177114
GARCIA PHILIP A
14791 LAGUNA DRIVE
FORT MYERS
FL
33908
1
0
0
0
Common stock, par value $0.01
2021-08-19
4
P
0
2772
56.49
A
16415
D
/s/Kathryn H. Shirley, attorney-in-fact for Philip A. Garcia
2021-08-23