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 BRP GROUP, INC. |
| 4211 W. BOY SCOUT BLVD., SUITE 800 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
06/05/2023
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3. Issuer Name and Ticker or Trading Symbol
BRP Group, Inc.
[ BRP ]
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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) |
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Other (specify below) |
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|
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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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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)
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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: |
|
| No securities are beneficially owned. |
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/s/ Seth Cohen, as Attorney-in-Fact, for Sathish Muthukrishnan |
06/09/2023 |
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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. |
LIMITED POWER OF ATTORNEY
June 5, 2023
Know all by these presents, that the undersigned hereby makes, constitutes and
appoints each of Kristopher Wiebeck, Bradford Hale and Seth Cohen as the
undersigned's true and lawful attorney-in-fact, with full power and authority as
hereinafter described on behalf of and in the name, place and stead of the
undersigned to:
1. Prepare, execute, acknowledge, deliver and file Schedules 13G, 13D,
Forms 3, 4, and 5 (including any amendments thereto), including
applications for Form ID, and any actions or documents necessary to
facilitate the timely filing of beneficial ownership reports, with
respect to the securities of BRP Group, Inc., a Delaware corporation
(the "Company"), with the United States Securities and Exchange
Commission, any national securities exchanges and the Company, as
considered necessary or advisable under Sections 13(d) and 16(a) of the
Securities Exchange Act of 1934 and the rules and regulations
promulgated thereunder, as amended from time to time (the "Exchange
Act");
2. Seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information on transactions in the Company's
securities from any third party, including brokers, employee benefit
plan administrators and trustees, and the undersigned hereby authorizes
any such person to release any such information to the undersigned and
approves and ratifies any such release of information; and
3. Perform any and all other acts which in the discretion of the
attorney-in-fact are necessary or desirable for and on behalf of the
undersigned in connection with the foregoing.
The undersigned acknowledges that:
1. This Limited Power of Attorney authorizes, but does not require, each
attorney-in-fact to act in his discretion on information provided to
each such attorney-in-fact without independent verification of such
information;
2. Any documents prepared and/or executed by the attorney-in-fact on behalf
of the undersigned pursuant to this Limited Power of Attorney will be in
such form and will contain such information and disclosure as each such
attorney-in-fact, in his discretion, deems necessary or desirable;
3. None of the Company or any such attorney-in-fact assumes (i) any
liability for the undersigned's responsibility to comply with the
requirements of the Exchange Act, (ii) any liability of the undersigned
for any failure to comply with such requirements, or (iii) any
obligation or liability of the undersigned for profit disgorgement under
Section 13 or 16 of the Exchange Act; and
4. This Limited Power of Attorney does not relieve the undersigned from
responsibility for compliance with the undersigned's obligations under
the Exchange Act, including without limitation the reporting
requirements under Sections 13(d) and 16 of the Exchange Act. The
undersigned hereby gives and grants each attorney-in-fact full power and
authority to do and perform all and every act and thing whatsoever
requisite, necessary or appropriate to be done in and about the
foregoing matters as fully to all intents and purposes as the
undersigned might or could do if present, hereby ratifying all that each
such attorney-in-fact of, for and on behalf of the undersigned, shall
lawfully do or cause to be done by virtue of this Limited Power of
Attorney.
This Limited Power of Attorney shall remain in full force and effect until
revoked by the undersigned in a signed writing delivered to each
attorney-in-fact.
IN WITNESS WHEREOF, the undersigned hereto have caused this Limited Power of
Attorney to be duly executed as of the day and year first above written.
By: /s/ Sathish Muthukrishnan
--------------------------
Name: Sathish Muthukrishnan
