SEC FORM
4
SEC Form 4
| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Estimated average burden |
| hours per response: |
0.5 |
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|
 |
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
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. Issuer Name and Ticker or Trading Symbol
BRP Group, Inc.
[ BRP ]
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5. 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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3. Date of Earliest Transaction
(Month/Day/Year)
10/01/2022
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4. 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 |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
|---|
| 1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
Amount |
(A) or (D) |
Price |
| Class A Common Stock |
10/01/2022 |
|
A |
|
712 |
A |
$0
|
6,886 |
D |
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
|
/s/ Seth Cohen, as Attorney-in-Fact, for Jay A. Cohen |
10/04/2022 |
|
** 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
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. |
Exhibit 24
LIMITED POWER OF ATTORNEY
August 3, 2022
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.
JAY COHEN
By: /s/ Jay Cohen
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Name: Jay Cohen
