SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O JAMES RIVER GROUP HOLDINGS, LTD. |
| 90 PITTS BAY ROAD |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
11/06/2018
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3. Issuer Name and Ticker or Trading Symbol
James River Group Holdings, Ltd.
[ JRVR ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
|
Other (specify below) |
|
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Shares |
0 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
|
/s/ Sundar Srinivasan |
11/06/2018 |
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** Signature of Reporting Person |
Date |
| 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
5
(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. |
POWER OF ATTORNEY
The undersigned with respect to the matters described herein, hereby
constitutes and appoints Sarah C. Doran, Michael C. Crow, David B. Zoffer and
Jeanette L. Miller, each of whom may act individually, as my true and lawful
attorney-in-fact to:
(1) Execute for and on behalf of the undersigned all forms or documents
(collectively, the "Forms") to be filed under the Securities Exchange Act
of 1934, as amended, and the rules thereunder (collectively, the "Exchange
Act") with respect to transactions by the undersigned in securities issued
by James River Group Holdings, Ltd. (the "Company"), including without
limitation any Forms 3, 4 or 5, Form 144 or Schedule 13D, and any
amendments to any of the foregoing;
(2) Do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to complete and execute any such Forms and
timely file such Forms with the United States Securities and Exchange
Commission and any stock exchange or similar authority; and
(3) Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit
to, in the best interest of, or legally required by, the undersigned. The
undersigned understands and confirms that the Forms executed by such
attorney-in-fact on behalf of the undersigned pursuant to this Power of
Attorney shall be in such form and shall contain such terms and conditions
as such attorney-in-fact may approve in such attorney-in-fact's discretion.
The undersigned hereby grants to such attorney-in-fact full power and authority
to do and perform any and every act and thing whatsoever requisite, necessary
or proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-fact shall lawfully do or
cause to be done by virtue of this power of attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing attorney-in-
fact, in serving in such capacity at the request of the undersigned, is not
assuming, nor is the Company assuming, and shall not be liable or responsible
for, nor shall the Company be liable or responsible for, any of the
undersigned's responsibilities to comply with the Exchange Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to
securities issued by the Company, unless earlier revoked with respect to any of
the attorneys-in-fact named herein by the undersigned in a signed writing
delivered to such person or persons or the Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 6th day of November, 2018.
/s/ Sundar Srinivasan
_________________________
Name: Sundar Srinivasan
