0000899243-22-031380.txt : 20220916 0000899243-22-031380.hdr.sgml : 20220916 20220916185510 ACCESSION NUMBER: 0000899243-22-031380 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20220914 FILED AS OF DATE: 20220916 DATE AS OF CHANGE: 20220916 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DIXON DONALD R CENTRAL INDEX KEY: 0001045434 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41314 FILM NUMBER: 221249095 MAIL ADDRESS: STREET 1: 400 S EL CAMINO REAL SUITE 1050 CITY: SAN MATEO STATE: CA ZIP: 94402 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Amprius Technologies, Inc. CENTRAL INDEX KEY: 0001899287 STANDARD INDUSTRIAL CLASSIFICATION: MISCELLANEOUS ELECTRICAL MACHINERY, EQUIPMENT & SUPPLIES [3690] IRS NUMBER: 981591811 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1180 PAGE AVENUE CITY: FREMONT STATE: CA ZIP: 94538 BUSINESS PHONE: (800) 425-8803 MAIL ADDRESS: STREET 1: 1180 PAGE AVENUE CITY: FREMONT STATE: CA ZIP: 94538 FORMER COMPANY: FORMER CONFORMED NAME: Kensington Capital Acquisition Corp. IV DATE OF NAME CHANGE: 20211214 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2022-09-14 0 0001899287 Amprius Technologies, Inc. AMPX 0001045434 DIXON DONALD R C/O AMPRIUS TECHNOLOGIES, INC., 1180 PAGE AVENUE FREMONT CA 94538 1 0 0 0 Common Stock 100000 I See Footnote Common Stock 96267 I See Footnotes Common Stock 3733 I See Footnotes Warrants (right to buy) 12.50 2027-09-14 Common Stock 100000 I See Footnote Warrants (right to buy) 12.50 2027-09-14 Common Stock 96267 I See Footnote Warrants (right to buy) 12.50 2027-09-14 Common Stock 3733 I See Footnote The securities are held directly by The Dixon Revocable Trust, for which the Reporting Person and his spouse are co-trustees. The securities are held directly by Trident Capital Fund-VI, L.P. Trident Capital Management VI, L.L.C. ("TCM VI") is the sole general partner of Trident Capital Fund VI, L.P. ("Trident Fund VI") and the sole managing member of Trident Capital Fund - VI Principals Fund, L.L.C. ("Trident Principals VI"). The Reporting Person is a managing member of TCM VI and, as such, may be deemed to have shared voting and dispositive power with respect to the issuer's securities held of record by each of Trident Fund VI and Trident Principals VI. The Reporting Person disclaims beneficial ownership of the securities reported herein, except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of the shares for purposes of Section 16 or for any other purpose. The securities are held directly by Trident Principals VI. The securities become exercisable on October 14, 2022, provided that in no event are the securities exercisable unless a registration statement registering the shares issuable on exercise thereof has been declared effective. Exhibit 24 - Power of Attorney /s/ Sandra Wallach, attorney-in-fact on behalf of Donald Dixon 2022-09-16 EX-24 2 attachment1.htm EX-24 DOCUMENT

                            LIMITED POWER OF ATTORNEY

        The undersigned, as a Section 16 reporting person of Amprius
Technologies, Inc. (the "Company"), hereby constitutes and appoints Kang Sun,
Sandra Wallach, Michael J. Danaher and Mark B. Baudler, each individually, the
undersigned's true and lawful attorneys-in-fact, with full power and authority
as hereinafter described on behalf of and in the name, place and stead of the
undersigned, to:

        1.    complete and execute Forms 3, 4 and 5 and other forms and all
              amendments thereto as such attorneys-in-fact shall in their
              discretion determine to be required or advisable pursuant to
              Section 16 of the Securities Exchange Act of 1934, as amended and
              the rules and regulations promulgated thereunder, or any
              successor laws and regulations, as a consequence of the
              undersigned's ownership, acquisition or disposition of securities
              of the Company; and

        2.    do all acts necessary in order to file such forms with the
              Securities and Exchange Commission, any securities exchange or
              national association, the Company and such other person or agency
              as the attorneys-in-fact shall deem appropriate.

        The undersigned hereby ratifies and confirms all that said attorneys-
in-fact and shall do or cause to be done by virtue hereof. The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, are not assuming, nor is the Company
assuming, any of the undersigned's responsibilities to comply with Section 16
of the Securities Exchange Act of 1934, as amended.

        This Limited Power of Attorney shall remain in full force and effect
until the undersigned is no longer required to file Forms 3, 4 and 5 with
respect to the undersigned's holdings of and transactions in securities issued
by the Company, unless earlier revoked by the undersigned in a signed writing
delivered to the Company and the foregoing attorneys-in-fact.

IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 15 day of September, 2022.

                                   Signature: /s/ Donald R. Dixon
                                              -------------------
                                   Print Name: Donald R. Dixon