-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DGBlq8mR5eY/qwpLlEJLLF9BtJbYq6FGTGal4YYzrMJL/b1bxlS5cQYQzYV7nN1F OEa89rkXJ/iYuTonug/rBg== 0000950116-97-001426.txt : 19970808 0000950116-97-001426.hdr.sgml : 19970808 ACCESSION NUMBER: 0000950116-97-001426 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19970729 FILED AS OF DATE: 19970807 SROS: NONE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: DYCOM INDUSTRIES INC CENTRAL INDEX KEY: 0000067215 STANDARD INDUSTRIAL CLASSIFICATION: WATER, SEWER, PIPELINE, COMM AND POWER LINE CONSTRUCTION [1623] IRS NUMBER: 591277135 STATE OF INCORPORATION: FL FISCAL YEAR END: 0731 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-10613 FILM NUMBER: 97653316 BUSINESS ADDRESS: STREET 1: 4440 PGA BLVD. SUITE 600 STREET 2: FIRST UNION CENTER CITY: PALM BEACH GARDENS STATE: FL ZIP: 33410 BUSINESS PHONE: (561) 627-7171 MAIL ADDRESS: STREET 1: P O BOX 3524 STREET 2: SUITE 860 CITY: WEST PALM BEACH STATE: FL ZIP: 33402 FORMER COMPANY: FORMER CONFORMED NAME: MOBILE HOME DYNAMICS INC DATE OF NAME CHANGE: 19820302 COMPANY DATA: COMPANY CONFORMED NAME: POLIS THOMAS CENTRAL INDEX KEY: 0001043471 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 235 EAST GAY STREET CITY: WEST CHESTER STATE: PA ZIP: 19380 MAIL ADDRESS: STREET 2: 235 EAST GAY STREET CITY: WEST CHESTER STATE: PA ZIP: 19380 3 1 - ------ ------------------------------------ FORM 3 OMB APPROVAL - ------ ------------------------------------ OMB Number 3235-0104 Expires: September 30, 1998 Estimated average burden hours per response .............0.5 ------------------------------------ U. S. SECURITIES AND EXCHANGE COMMISSION Washington, D. C. 20549 INITITAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 - ------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Polis Thomas -------------------------------------------------------------------- (Last) (First) (MI) 235 East Gay Street -------------------------------------------------------------------- (Street) West Chester PA 19380 -------------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 7/29/97 - ------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) - ------------------------------------------------------------------------------- 4. Issuer Name and Ticker or Trading Symbol Dycom Industries, Inc.; DY - ------------------------------------------------------------------------------- 5. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [ X ] Officer (give title below) [ ] Other (specify below) Executive Vice President of Subsidiary --------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) - ------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Box) [ X ] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person TABLE I - Non-Derivative Securities Beneficially Owned - -------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Indirect Beneficial (Instr. 4) | Beneficially Owned | Direct (D) or Indirect | Ownership (Instr. 5) | (Instr. 4) | (I) (Instr. 5) | - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock | 1,026,621 shares | D | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | - -----------------------------------------------------------------------------------------------------------------------------------
Reminder: Report on a seperate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 5(b)(iv). (Print or Type Responses) (Over) SEC 1473 (7/96)
FORM 3 (continued) Table II -- Derivative Securities Benefically Owned (e.g., puts, calls, warrants, options, convertible securities) - --------------------------------------------------------------------------------------------- 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date | (Month/Day/Year) |----------------------------------------- | Date Exercisable | Expiration Date - --------------------------------------------------------------------------------------------- | | a) | | | | - --------------------------------------------------------------------------------------------- | | b) | | | | - --------------------------------------------------------------------------------------------- | | c) | | | | - --------------------------------------------------------------------------------------------- | | d) | | | | ============================================================================================= =================================================================================================================================== 3. Title and Amount of Securities | 4. Conversion or Exercise | 5. Ownership Form of Derivative | 6. Nature of Indirect Underlying Derivative Security | Price of Derivative | Security: Direct (D) or | Beneficial Ownership (Instr. 4) | Security | Indirect (I) (Instr. 5) | (Instr. 5) - -----------------------------------------| | | | Amount of | | | | Number of | | | Title | Shares | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | | a) | | | | | | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | | b) | | | | | | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | | c) | | | | | | | | - ----------------------------------------------------------------------------------------------------------------------------------- | | | | d) | | | | | | | | - ----------------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: The filing of this Statement shall not be construed as an admission (a) that the person filing this Statement is, for the purposes of Section 16 of the Securities Exchange Act of 1934 (as amended), the beneficial owner of any equity securities covered by this Statement, or (b) that this Statement is legally required to be filed by such person. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. /s/ Thomas Polis August 6, 1997 - -------------------------------------------------------- ------------------- **Signature of Reporting Person Date Thomas Polis Page 2 SEC 1473 (7/96)
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