# EDGAR Filing Document

**Accession Number:** 0001722438
**File Stem:** 0001722438-23-000015
**Filing Date:** 2023-2
**Character Count:** 8732
**Document Hash:** 2c3420d62d2849060e6fd3f95c6ae9cc
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001722438-23-000015.hdr.sgml**: 20230203

**ACCESSION NUMBER**: 0001722438-23-000015

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230202

**FILED AS OF DATE**: 20230203

**DATE AS OF CHANGE**: 20230203

**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:** 23586031

**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:** 23586030

**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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Simkoff Maxwell<br><sub>(Last) (First) (Middle)</sub><br>101 MISSION ST.<br>SUITE 740<br><sub>(Street)</sub><br>SAN FRANCISCO, CA 94105<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-02 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Executive Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Doma Holdings, Inc. [ DOMA ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Saslaw-Simkoff Revocable Trust<br><sub>(Last) (First) (Middle)</sub><br>101 MISSION ST.<br>SUITE 740<br><sub>(Street)</sub><br>SAN FRANCISCO, CA 94105<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-02 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [X] 10% Owner<br>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Doma Holdings, Inc. [ DOMA ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common stock | 2023-02-02 |  | S |  | 33361<sup>(1)</sup> | D | 0.731<sup>(2)</sup> | 46028052<sup>(3)</sup> | I | By The Saslaw-Simkoff Revocable Trust |
| Common stock |  |  |  |  |  |  |  | 5219014 | D |  |
| Common stock |  |  |  |  |  |  |  | 346609<sup>(4)</sup> | I | By Max Simkoff 2020 GRAT |
| Common stock |  |  |  |  |  |  |  | 346609<sup>(5)</sup> | I | By Jennifer Saslaw 2020 GRAT |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) This transaction was made pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on May 13, 2022.

(2) The price reported above in Column 4 represents a weighted average sales price. This transaction was executed in multiple trades at prices ranging from $0.71 to $0.75, inclusive. The reporting person hereby undertakes to provide, upon request, to Doma Holdings, Inc. (the "Issuer"), any security holder of the Issuer, or the staff of the Securities and Exchange Commission, full information regarding the number of shares and prices at which the transaction was effected.

(3) 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.

(4) These shares are owned directly by the Max Simkoff 2020 GRAT. The reporting person disclaims beneficial ownership except to the extent of his pecuniary interest therein.

(5) 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.

**Signature:** /s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff  
**Date:** 2023-02-03

**Signature:** /s/ Christian Ameri, as Attorney-in-Fact for Maxwell Simkoff, Trustee  
**Date:** 2023-02-03

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

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

** 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 is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**