0000950103-21-011669.txt : 20210730 0000950103-21-011669.hdr.sgml : 20210730 20210730213238 ACCESSION NUMBER: 0000950103-21-011669 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: Rizvi Hasan CENTRAL INDEX KEY: 0001868803 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39754 FILM NUMBER: 211134362 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 dp155506_4-rizvi.xml FORM 4 X0306 4 2021-07-28 0 0001722438 Doma Holdings, Inc. DOMA 0001868803 Rizvi Hasan 101 MISSION ST. SUITE 740 SAN FRANCISCO CA 94105 0 1 0 0 Chief Technology Officer Common Stock 2021-07-28 4 A 0 599493 A 599493 D Stock Options (Right to Buy) 0.45 2021-07-28 4 A 0 2386419 A 2029-04-15 Common stock 2386419 2386419 D Stock Options (Right to Buy) 0.71 2021-07-28 4 A 0 149873 A 2030-06-02 Common stock 149873 149873 D Stock Options (Right to Buy) 0.71 2021-07-28 4 A 0 59949 A 2031-01-27 Common stock 59949 59949 D 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"). The option vests in 25% on the first anniversary of March 18, 2019 and in equal monthly installments thereafter until it is fully vested on the fourth anniversary of such date. The stock option was received in the Merger in exchange for a stock option to acquire shares of Former Doma common stock. The option vests in 25% on the first anniversary of March 1, 2020 and in equal monthly installments thereafter until it is fully vested on the fourth anniversary of such date. The stock option was received in the Merger in exchange for a stock option to acquire shares of Former Doma common stock. The option vests in 25% on the first anniversary of March 1, 2021 and in equal monthly installments thereafter until it is fully vested on the fourth anniversary of such date. The stock option was received in the Merger in exchange for a stock option to acquire shares of Former Doma common stock. /s/ Christian Ameri, as Attorney-in-Fact for Hasan Rizvi 2021-07-30