0000950103-21-011665.txt : 20210730 0000950103-21-011665.hdr.sgml : 20210730 20210730210629 ACCESSION NUMBER: 0000950103-21-011665 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210728 FILED AS OF DATE: 20210730 DATE AS OF CHANGE: 20210730 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simkoff Maxwell CENTRAL INDEX KEY: 0001868802 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 211134334 MAIL ADDRESS: STREET 1: 101 MISSION ST. STREET 2: SUITE 740 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Saslaw-Simkoff Revocable Trust CENTRAL INDEX KEY: 0001875424 STATE OF INCORPORATION: CA FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 211134333 BUSINESS ADDRESS: STREET 1: 101 MISSION ST. STREET 2: SUITE 740 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 BUSINESS PHONE: 703-789-5646 MAIL ADDRESS: STREET 1: 101 MISSION ST. STREET 2: SUITE 740 CITY: SAN FRANCISCO STATE: CA ZIP: 94105 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 dp155562_4-simkoff.xml FORM 4 X0306 4 2021-07-28 0 0001722438 Doma Holdings, Inc. DOMA 0001868802 Simkoff Maxwell 101 MISSION ST. SUITE 740 SAN FRANCISCO CA 94105 1 1 1 0 Chief Executive Officer 0001875424 Saslaw-Simkoff Revocable Trust 101 MISSION ST. SUITE 740 SAN FRANCISCO CA 94105 0 0 1 0 Common Stock 2021-07-28 4 A 0 47335909 A 47335909 I By The Saslaw-Simkoff Revocable Trust Common Stock 2021-07-28 4 A 0 705292 A 705292 I By Jennifer Saslaw 2020 GRAT Common Stock 2021-07-28 4 A 0 705292 A 705292 I By Max Simkoff 2020 GRAT Received in exchange for shares of common stock of Doma Holdings, Inc., which was formerly known as States Title Holding, Inc. ("Former Doma") in connection with the merger by and among Capitol Investment Corp V., Capitol V Merger Sub, Inc. and Former Doma (the "Merger"). These shares are owned directly by The Saslaw-Simkoff Revocable Trust and indirectly by Maxwell Simkoff as trustee of the trust. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein. Received in exchange for shares of common stock of Former Doma in connection with the Merger. These shares are held for the benefit of the reporting person's wife. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein. Received in exchange for shares of common stock of Former Doma in connection with the Merger. /s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff 2021-07-30 /s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff, Trustee 2021-07-30