-----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, Oci2W5hUECjgzN4Cblyfc1PkmYurB6XpjSgGaC3n+pkaHm+vm8Ud6j65RnaZWTzp eV8MLY6bwUiy5Ewut4gLNA== 0000950124-99-000612.txt : 19990201 0000950124-99-000612.hdr.sgml : 19990201 ACCESSION NUMBER: 0000950124-99-000612 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990119 FILED AS OF DATE: 19990129 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INSURANCE AUTO AUCTIONS INC /CA CENTRAL INDEX KEY: 0000880026 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MOTOR VEHICLES & MOTOR VEHICLE PARTS & SUPPLIES [5010] IRS NUMBER: 953790111 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-19594 FILM NUMBER: 99517430 BUSINESS ADDRESS: STREET 1: 850 E ALGONQUIN RD STREET 2: STE 100 CITY: SCHAUMGURG STATE: IL ZIP: 60173 BUSINESS PHONE: 847839-3939 MAIL ADDRESS: STREET 1: 1270 WEST NORTHWEST HIGHWAY CITY: PALATINE STATE: IL ZIP: 60067 COMPANY DATA: COMPANY CONFORMED NAME: INSURANCE AUTO AUCTIONS INC /CA CENTRAL INDEX KEY: 0000880026 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MOTOR VEHICLES & MOTOR VEHICLE PARTS & SUPPLIES [5010] DIRECTOR IRS NUMBER: 953790111 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 850 E ALGONQUIN RD STREET 2: STE 100 CITY: SCHAUMGURG STATE: IL ZIP: 60173 BUSINESS PHONE: 847839-3939 MAIL ADDRESS: STREET 1: 1270 WEST NORTHWEST HIGHWAY CITY: PALATINE STATE: IL ZIP: 60067 3 1 FORM 3 1
UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------- FORM 3 Washington, D.C. 20549 | OMB APPROVAL | |-----------------------------| | OMB Number: 3235-0104 | INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES | Expires: September 30,1998 | | Estimated average burden | | hours per response......0.5 | |-----------------------------| 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 (Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* | 2. Date of Event Re- | 4. Issuer Name and Ticker or Trading Symbol | quiring Statement | Kamin Peter H. | (Month/Day/Year) | IAAI - Insurance Auto Auctions, Inc. - ------------------------------------------ ----------------------------------------------------------------- (Last) (First) (Middle) | | 5. Relationship of Reporting Person(s) | 6. If Amendment, | 1-19-99 | to Issuer (Check all applicable) | Date of Original Peak Investment Limited Partnership ------------------------- __X___Director _____10% Owner | (Month/Day/Year) One Financial Center, Suite 1600 | 3. IRS or Social Se- | _____Officer (give _____Other (specify| - ------------------------------------------ curity Number of | tile below) below) | (Street) | Reporting Person | ---------------------- | (Voluntary) | | 7. Individual or | | | Joint/Group | | | Filing (Circle | | | Applicable Line) | | | _x_ Form filed by | | | One Reporting | | | Person | | | ___ Form filed by | | | More than One Boston MA 02111 | | ------------------------------ | Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) | | | | | | Table 1 -- Non Derivative Securities Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security | 2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial (Instr. 4) | Beneficially Owned | Form: Direct | Ownership (Instr. 5) | (Instr. 4) | (D) or Indirect | | | (I) (Instr. 5) | - ------------------------------------------------------------------------------------------------------------------------------------ | | | Common Stock | 35,900 | D | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | 974,400 | I | 1(See Footnote) - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- | | | - -----------------------------------------------|-----------------------------|--------------------|--------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) * If the form is filed by more than one reporting person, see Instruction 5(b)(v). (over) SEC 1473 (7-96)
2 FORM 3 (continued) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Tile of Derivative | 2. Date Exer- | 3. Title and Amount | 4. Conversion or | 5. Ownership | 6. Nature Of Security (Instr. 4)| cisable and | of Securities | Exercise | Form of | Indirect | Expiration Date | Underlying | Price of | Derivative | Beneficial | (Month/Day/Year) | Derivative | Derivative | Security: | Ownership | | Security | Security | Direct (D) | (Instr. 5) | | (Instr. 4) | | or Indirect | | | | | (I) (Instr. 5) | |------------------------------------------------| | | | Date | Expira-| Title | Amount of | | | | Exer- | tion | | Number of | | | | cisable | Date | | Shares | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- | | | | | | | - ----------------------|---------|--------|---------------|-------------|--------------------|----------------------|---------------- Explanation of Responses: 1 Peter H. Kamin, by reason of his position as the sole director, officer and stockholder of Peak Management, Inc., which is the sole General Partner of Peak L.P., Peter H. Kamin may be deemed to have indirect shared voting and dispositive power over the 974,400 shares of Common Stock beneficially owned by such partnership. Accordingly, Peter H. Kamin may be deemed the beneficial owner of an aggregate 1,010,300 shares of Common Stock. ** Intentional misstatements or omissions of facts constitute Federal /s/ Peter H. Kamin Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). -------------------------------- ---------------- **Signature of Reporting Person Date 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. Page 2 SEC 1473 (7-96)
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