-----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, WEvpuXIJmrUZC7UFSu0hebS7ynJnzZaBa2JyjjqMYGwTi4Hh/ijDyADKOPWBHv/z l1GnRiO/cHbHU5lvkjdS3w== 0000950144-03-001282.txt : 20030206 0000950144-03-001282.hdr.sgml : 20030206 20030206160540 ACCESSION NUMBER: 0000950144-03-001282 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030205 FILED AS OF DATE: 20030206 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: REPUBLIC SERVICES INC CENTRAL INDEX KEY: 0001060391 STANDARD INDUSTRIAL CLASSIFICATION: REFUSE SYSTEMS [4953] IRS NUMBER: 650716904 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14267 FILM NUMBER: 03542675 BUSINESS ADDRESS: STREET 1: 110 SE 6TH STT 28TH FLR CITY: FORT LAUDERDALE STATE: FL ZIP: 33301 BUSINESS PHONE: 9547692400 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: HUIZENGA H WAYNE CENTRAL INDEX KEY: 0000917702 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 2215 YORK RD STREET 2: SUITE 600 CITY: OAKBROOK STATE: IL ZIP: 60521 BUSINESS PHONE: 6309902100 MAIL ADDRESS: STREET 1: 2215 YORK RD STREET 2: SUITE 600 CITY: OAKBROOK STATE: IL ZIP: 60521 5 1 g80513hwe5.htm REPUBLIC SERVICES INC. - H. WAYNE HUIZENGA Republic Services Inc. - H. Wayne Huizenga
 

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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 5

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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(h) of the Investment Company Act of 1940

o Check box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
o Form 3 Holdings Reported
o Form 4 Transactions Reported

1. Name and Address of Reporting
Person*
2. Issuer Name and Ticker or Trading
Symbol
3. I.R.S. Identification Number of Reporting
Person, if an entity
(Voluntary)
  Huizenga, H. Wayne
(Last) (First) (Middle)
  Republic Services, Inc. (RSG)
 
   
                 
  450 East Las Olas Blvd., Suite 1500
4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year)
    February 5, 2003
 
  (Street) 6. Relationship of Reporting Person(s)
to Issuer
(Check All Applicable)
7. Individual or Joint/Group Reporting
(Check Applicable Line)
  Fort Lauderdale, FL 33316
(City)        (State)        (Zip)
  x  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
     
     

*   If the form is filed by more than one reporting person, see instruction 4(b)(v).


 

                                                 

Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of
Security

(Instr. 3)
2. Transaction
Date

(Month/Day/Year)
2A. Deemed Execution
Date, if any

(Month/Day/Year)
3. Transaction
Code

(Instr. 8)
4. Securities Acquired (A)
or Disposed of (D)

(Instr. 3, 4 and 5)
5. Amount of Securities
Beneficially Owned
at the End of Issuer's
Fiscal Year

(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)

(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

                    Amount (A)
or
(D)
Price            

                     

                     

                     

                     

                     

                     

                     

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Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
Security

(Instr. 3)
2. Conversion or Exercise
Price of Derivative
Security
3. Transaction Date
(Month/Day/Year)
3A. Deemed Execution
Date, if any

(Month/Day/Year)
4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)

(Instr. 3, 4 and 5)

                            (A) (D)

  Common Stock Option     $17.40     1/31/2002     AV   200,000

               

               

               

               

               

               

               

               

Page 3


 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date

(Month/Day/Year)
7. Title and Amount of
Underlying Securities

(Instr. 3 and 4)
8. Price of Derivative
Security

(Instr. 5)
9. Number of Derivative
Securities Beneficially
Owned at End of
Year

(Instr. 4)
10. Ownership of
Derivative Security:
Direct (D)
or Indirect (I)

(Instr. 4)
11. Nature of
Indirect
Beneficial
Ownership

(Instr. 4)

  Date
Exercisable
Expiration
Date
  Title Amount or
Number of
Shares
                       

  (1) 1/31/2012   Common Stock 200,000           200,000     D  

                   

                   

                   

                   

                   

                   

                   

                   

Explanation of Responses:

(1) The options will vest in four equal installments commencing on the first anniversary of the date of grant.

/s/ H. Wayne Huizenga   2/6/03

**Signature of Reporting Person
 
Date


**   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.

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