0001722438-21-000064.txt : 20211115 0001722438-21-000064.hdr.sgml : 20211115 20211115162434 ACCESSION NUMBER: 0001722438-21-000064 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211111 FILED AS OF DATE: 20211115 DATE AS OF CHANGE: 20211115 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Smith Michael Alan CENTRAL INDEX KEY: 0001543844 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 211411100 MAIL ADDRESS: STREET 1: C/O CAPITALSOURCE INC. STREET 2: 5404 WISCONSIN AVENUE, 2ND FLOOR CITY: CHEVY CHASE STATE: MD ZIP: 20815 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Doma Holdings, Inc. CENTRAL INDEX KEY: 0001722438 STANDARD INDUSTRIAL CLASSIFICATION: TITLE INSURANCE [6361] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 101 MISSION STREET STREET 2: SUITE 740 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: (650) 419-3827 MAIL ADDRESS: STREET 1: 101 MISSION STREET STREET 2: SUITE 740 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 FORMER COMPANY: FORMER CONFORMED NAME: Capitol Investment Corp. V DATE OF NAME CHANGE: 20171113 4 1 wf-form4_163701145341683.xml FORM 4 X0306 4 2021-11-11 0 0001722438 Doma Holdings, Inc. DOMA 0001543844 Smith Michael Alan 101 MISSION ST. SUITE 740 SAN FRANCISCO CA 94105 0 1 0 0 Chief Accounting Officer Common stock 2021-11-11 4 P 0 14400 7.10 A 144271 D /s/ Christian Ameri, as Attorney-in-Fact for Michael Alan Smith 2021-11-15