0001213900-20-041644.txt : 20201208 0001213900-20-041644.hdr.sgml : 20201208 20201208171935 ACCESSION NUMBER: 0001213900-20-041644 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201204 FILED AS OF DATE: 20201208 DATE AS OF CHANGE: 20201208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Capitol Acquisition Founder V, LLC CENTRAL INDEX KEY: 0001833381 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 201376113 BUSINESS ADDRESS: STREET 1: 1300 17TH STREET NORTH STREET 2: SUITE 820 CITY: ARLINGTON STATE: VA ZIP: 22209 BUSINESS PHONE: (202) 654-7060 MAIL ADDRESS: STREET 1: 1300 17TH STREET NORTH STREET 2: SUITE 820 CITY: ARLINGTON STATE: VA ZIP: 22209 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dryden L. Dyson CENTRAL INDEX KEY: 0001574445 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 201376114 MAIL ADDRESS: STREET 1: 305 WEST PENNSYLVANIA AVENUE CITY: TOWSON STATE: MD ZIP: 21204 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Capitol Investment Corp. V CENTRAL INDEX KEY: 0001722438 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 000000000 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ARLINGTON TOWER STREET 2: 1300 N 17TH STREET, SUITE 820 CITY: ARLINGTON STATE: VA ZIP: 22209 BUSINESS PHONE: (202) 654-7060 MAIL ADDRESS: STREET 1: ARLINGTON TOWER STREET 2: 1300 N 17TH STREET, SUITE 820 CITY: ARLINGTON STATE: VA ZIP: 22209 4 1 ownership.xml ONWERSHIP DCOUMENT X0306 4 2020-12-04 0 0001722438 Capitol Investment Corp. V CAP 0001833381 Capitol Acquisition Founder V, LLC 1300 17TH STREET NORTH, SUITE 820 ARLINGTON VA 22209 0 0 1 0 0001574445 Dryden L. Dyson C/O CAPITOL INVESTMENT CORP. V. 1300 17TH STREET NORTH, SUITE 820 ARLINGTON, VA 22209 1 1 1 0 President, CFO Warrants 11.50 2020-12-04 4 P 0 1942980 1.50 A Class A Common Stock 1942980 1942980 I See footnote The warrants will become exercisable commencing on the later of 12 months from the closing of the Issuer's initial public offering and 30 days after the completion of the Issuer's initial business combination, and will expire five years after the completion of the Issuer's initial business combination or earlier upon redemption or liquidation. Represents warrants held by Capitol Acquisition Founder V LLC, which is controlled by Mr. Dryden. /s/ L. Dyson Dryden, Managing Member 2020-12-08 /s/ L. Dyson Dryden 2020-12-08