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