-----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, NDrdPN8p4v7InmUQRC7GUg0d4qx1Q7tg54JwblLhWkj+FUkXlRxDdeTly3j06n8Y BCLK1ZOhB+jSgwIk+98yFw== 0001104659-04-004349.txt : 20040213 0001104659-04-004349.hdr.sgml : 20040213 20040213165859 ACCESSION NUMBER: 0001104659-04-004349 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 3 FILED AS OF DATE: 20040213 GROUP MEMBERS: CD&R ASSOCIATES V LIMITED PARTNERSHIP GROUP MEMBERS: CD&R ASSOCIATES VI LIMITED PARTNERSHIP GROUP MEMBERS: CD&R INVESTMENT ASSOCIATES II, INC. GROUP MEMBERS: CD&R INVESTMENT ASSOCIATES VI, INC. GROUP MEMBERS: CLAYTON, DUBILIER & RICE FUND VI LIMITED PARTNERSHIP SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SIRVA INC CENTRAL INDEX KEY: 0001181232 STANDARD INDUSTRIAL CLASSIFICATION: TRUCKING (NO LOCAL) [4213] IRS NUMBER: 522070058 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-79576 FILM NUMBER: 04600071 BUSINESS ADDRESS: STREET 1: 700 OAKMONT LANE CITY: WESTMONT STATE: IL ZIP: 60559 BUSINESS PHONE: 6304684743 MAIL ADDRESS: STREET 1: 700 OAKMONT LANE CITY: WESTMONT STATE: IL ZIP: 60559 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: CLAYTON DUBILIER & RICE FUND V L P CENTRAL INDEX KEY: 0000942674 STANDARD INDUSTRIAL CLASSIFICATION: UNKNOWN SIC - 0000 [0000] IRS NUMBER: 061418132 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 1403 FOULK RD STREET 2: STE 106 CITY: WILMINGTON STATE: DE ZIP: 19803 BUSINESS PHONE: 3024771679 MAIL ADDRESS: STREET 1: 1403 FOULK RD STREET 2: STE 106 CITY: WILMINGTON STATE: DE ZIP: 19803 SC 13G 1 a04-1957_1sc13g.htm SC 13G

 

UNITED STATES

 

 

SECURITIES AND EXCHANGE COMMISSION

 

 

Washington, D.C. 20549

 

 

 

 

 

SCHEDULE 13G

 

 

Under the Securities Exchange Act of 1934*

 

SIRVA, Inc.

(Name of Issuer)

 

Common Stock, par value $0.01 per share

(Title of Class of Securities)

 

82967Y 10 4

(CUSIP Number)

 

November 24, 2003

(Date of Event Which Requires Filing of this Statement)

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

o

Rule 13d-1(b)

o

Rule 13d-1(c)

ý

Rule 13d-1(d)

 

*The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

 

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

 



 

CUSIP No.  82967Y 10 4

Page 2 of 12 Pages

 

 

1.

Names of Reporting Persons.
Clayton, Dubilier & Rice Fund V Limited Partnership
I.R.S. Identification Nos. of above persons (entities only).

 

 

2.

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

(a)

ý

 

 

(b)

o

 

 

3.

SEC Use Only

 

 

4.

Citizenship or Place of Organization
Cayman Islands

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5.

Sole Voting Power
0

 

6.

Shared Voting Power
27,697,466(1)

 

7.

Sole Dispositive Power
0

 

8.

Shared Dispositive Power
27,697,466(1)

 

 

9.

Aggregate Amount Beneficially Owned by Each Reporting Person
27,697,466(1)

 

 

10.

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11.

Percent of Class Represented by Amount in Row (9)
39.3%(2)

 

 

12.

Type of Reporting Person (See Instructions)
PN

 


(1)   See Item 4(c), below.

(2)   Based on 70,446,150 shares outstanding.

 

 



 

CUSIP No.  82967Y 10 4

Page 3 of 12 Pages

 

 

1.

Names of Reporting Persons.
CD&R Associates V Limited Partnership
I.R.S. Identification Nos. of above persons (entities only).

 

 

2.

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

(a)

ý

 

 

(b)

o

 

 

3.

SEC Use Only

 

 

4.

Citizenship or Place of Organization
Cayman Islands

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5.

Sole Voting Power
-0-

 

6.

Shared Voting Power
27,697,466(1)

 

7.

Sole Dispositive Power
-0-

 

8.

Shared Dispositive Power
27,697,466(1)

 

 

9.

Aggregate Amount Beneficially Owned by Each Reporting Person
27,697,466(1)

 

 

10.

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11.

Percent of Class Represented by Amount in Row (9)
39.3%(2)

 

 

12.

Type of Reporting Person (See Instructions)
PN

 


(1)   See Item 4(c), below.

(2)   Based on 70,446,150 shares outstanding.

 

 



 

CUSIP No.  82967Y 10 4

Page 4 of 12 Pages

 

 

1.

Names of Reporting Persons.
CD&R Investment Associates II, Inc.
I.R.S. Identification Nos. of above persons (entities only).

 

 

2.

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

(a)

ý

 

 

(b)

o

 

 

3.

SEC Use Only

 

 

4.

Citizenship or Place of Organization
Cayman Islands

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5.

Sole Voting Power
-0-

 

6.

Shared Voting Power
27,697,466(1)

 

7.

Sole Dispositive Power
-0-

 

8.

Shared Dispositive Power
27,697,466(1)

 

 

9.

Aggregate Amount Beneficially Owned by Each Reporting Person
27,697,466(1)

 

 

10.

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11.

Percent of Class Represented by Amount in Row (9)
39.3%(2)

 

 

12.

Type of Reporting Person (See Instructions)
CO

 


(1)   See Item 4(c), below.

(2)   Based on 70,446,150 shares outstanding.

 

 



 

CUSIP No.  82967Y 10 4

Page 5 of 12 Pages

 

 

1.

Names of Reporting Persons.
Clayton, Dubilier & Rice Fund VI Limited Partnership
I.R.S. Identification Nos. of above persons (entities only).

 

 

2.

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

(a)

ý

 

 

(b)

o

 

 

3.

SEC Use Only

 

 

4.

Citizenship or Place of Organization
Cayman Islands

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5.

Sole Voting Power
-0-

 

6.

Shared Voting Power
11,513,700(3)

 

7.

Sole Dispositive Power
-0-

 

8.

Shared Dispositive Power
11,513,700(3)

 

 

9.

Aggregate Amount Beneficially Owned by Each Reporting Person
11,513,700(3)

 

 

10.

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11.

Percent of Class Represented by Amount in Row (9)
16.3%(2)

 

 

12.

Type of Reporting Person (See Instructions)
PN

 


(3)   See Item 4(c), below.

(2)   Based on 70,446,150 shares outstanding.

 

 



 

CUSIP No.  82967Y 10 4

Page 6 of 12 Pages

 

 

1.

Names of Reporting Persons.
CD&R Associates VI Limited Partnership
I.R.S. Identification Nos. of above persons (entities only).

 

 

2.

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

(a)

ý

 

 

(b)

o

 

 

3.

SEC Use Only

 

 

4.

Citizenship or Place of Organization
Cayman Islands

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5.

Sole Voting Power
-0-

 

6.

Shared Voting Power
11,513,700(3)

 

7.

Sole Dispositive Power
-0-

 

8.

Shared Dispositive Power
11,513,700(3)

 

 

9.

Aggregate Amount Beneficially Owned by Each Reporting Person
11,513,700(3)

 

 

10.

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11.

Percent of Class Represented by Amount in Row (9)
16.3%(2)

 

 

12.

Type of Reporting Person (See Instructions)
PN

 


(3)   See Item 4(c), below.

(2)   Based on 70,446,150 shares outstanding.

 

 



 

CUSIP No.  82967Y 10 4

Page 7 of 12 Pages

 

 

1.

Names of Reporting Persons.
CD&R Investment Associates VI, Inc.
I.R.S. Identification Nos. of above persons (entities only).

 

 

2.

Check the Appropriate Box if a Member of a Group (See Instructions)

 

 

(a)

ý

 

 

(b)

o

 

 

3.

SEC Use Only

 

 

4.

Citizenship or Place of Organization
Cayman Islands

 

 

 

Number of
Shares
Beneficially
Owned by
Each
Reporting
Person With

5.

Sole Voting Power
-0-

 

6.

Shared Voting Power
11,513,700(3)

 

7.

Sole Dispositive Power
-0-

 

8.

Shared Dispositive Power
11,513,700(3)

 

 

9.

Aggregate Amount Beneficially Owned by Each Reporting Person
11,513,700(3)

 

 

10.

Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions)  o

 

 

11.

Percent of Class Represented by Amount in Row (9)
16.3%(2)

 

 

12.

Type of Reporting Person (See Instructions)
CO

 


(3)   See Item 4(c), below.

(2)   Based on 70,446,150 shares outstanding.

 

 



 

Item 1.

 

(a)

Name of Issuer
SIRVA, Inc.

 

(b)

Address of Issuer’s Principal Executive Offices
700 Oakmont Lane

Westmont, Illinois 60559

 

Item 2.

 

(a)

Name of Person Filing:
Clayton, Dubilier & Rice Fund V Limited Partnership (“Fund V”)

CD&R Associates V Limited Partnership (“Associates V LP”)

CD&R Investment Associates II, Inc. (“Investment Associates II”)

Clayton, Dubilier & Rice Fund VI Limited Partnership (“Fund VI”)

CD&R Associates VI Limited Partnership (“Associates VI LP”)

CD&R Investment Associates VI, Inc. (“Investment Associates VI”, each of Fund V, Associates V LP, Investment Associates II, Fund VI, Associates VI LP and Investment Associates VI, a “Reporting Person” and together, the “Reporting Persons”)

 

(b)

Address of Principal Business Office or, if none, Residence:
The principal business office of each of the Reporting Persons is located at 1403 Foulk Road, Suite 106, Wilmington, Delaware 19803.

 

(c)

Citizenship:
Fund V—Cayman Islands

Associates V LP—Cayman Islands

Investment Associates II—Cayman Islands

Fund VI—Cayman Islands

Associates VI LP—Cayman Islands

Investment Associates VI—Cayman Islands

 

(d)

Title of Class of Securities:
Common Stock, par value $0.01 per share, of the issuer

 

(e)

CUSIP Number:
82967Y 10 4

 

Item 3.

If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:

 

(a)

o

Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).

 

(b)

o

Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).

 

(c)

o

Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).

 

(d)

o

Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8).

 

(e)

o

An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);

 

(f)

o

An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);

 

(g)

o

A parent holding company or control person in accordance with § 240.13d-1(b)(1)(ii)(G);

 

(h)

o

A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);

 

(i)

o

A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);

 

(j)

o

Group, in accordance with §240.13d-1(b)(1)(ii)(J).

 

N/A

 

 

8



 

Item 4.

Ownership

Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.

 

(a)

Amount beneficially owned:    See below.

 

 

(b)

Percent of class:    See below.

 

 

(c)

Number of shares as to which the person has:

 

 

(i)

Sole power to vote or to direct the vote   

 

 

 

(ii)

Shared power to vote or to direct the vote    

 

 

 

(iii)

Sole power to dispose or to direct the disposition of   

 

 

 

(iv)

Shared power to dispose or to direct the disposition of   

 

 

 

As of the date of this report, each of the Reporting Persons owned of record the number and percentage of issued and outstanding shares(2) of common stock of SIRVA, Inc. (the “Shares”) listed opposite its name:

 

 

 

Amount Owned of Record

 

Percent of Class

 

Fund V

 

27,697,466 shares

 

39.3

%

Associates V LP

 

0 shares

 

0

%

Investment Associates II

 

0 shares

 

0

%

Fund VI

 

11,513,700 shares

 

16.3

%

Associates VI LP

 

0 shares

 

0

%

Investment Associates VI

 

0 shares

 

0

%

 

 

 

(A)          Fund V is a private investment fund.  Associates V LP is the general partner of Fund V.  Investment Associates II is the managing general partner of Associates V LP.

(B)           By virtue of its position as a general partner of Fund V, Associates V LP may be deemed to be a beneficial owner of all of the Shares of which Fund V has beneficial ownership.

(C)           By virtue of its position as the managing general partner of Associates V LP, Investment Associates II may be deemed to be the beneficial owner of all of the Shares of which Fund V has beneficial ownership.

(D)          Fund VI is a private investment fund.  Associates VI LP is the general partner of Fund VI.  Investment Associates VI is the general partner of Associates VI LP. 

(E)           By virtue of its position as general partner of Fund VI, Associates VI LP may be deemed to be the beneficial owner of all of the shares of which Fund VI has beneficial ownership.

(F)           By virtue of its position as general partner of Associates VI LP, Investment Associates VI may be deemed to be the beneficial owner of all of the shares of which Fund VI has beneficial ownership.

(G)           Fund V, Associates V LP and Investment Associates II may be deemed to share the power to vote or to direct the vote and to dispose or direct the disposition of the 27,697,466 Shares, or 39.3% of the issued and outstanding Shares, held by Fund V.

(H)          Fund VI, Associates VI LP and Investment Associates VI may be deemed to share the power to vote or to direct the vote and to dispose or direct the disposition of the 11,513,700 Shares, or 16.3% of the issued and outstanding Shares, held by Fund VI.

(I)            Each of Associates V LP and Investment Associates II expressly disclaims beneficial ownership of all of the Shares owned by Fund V and Fund VI.

 


(2)   Based on 70,446,150 shares outstanding.

 

 

9



 

 

 

(J)            Each of Associates VI LP and Investment Associates VI expressly disclaims beneficial ownership of all of the Shares owned by Fund VI and Fund V.

(K)          Each of Fund V and Fund VI expressly disclaims beneficial ownership of the Shares owned by the other.

 

Item 5.

Ownership of Five Percent or Less of a Class

 

If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following   o.

 

N/A

 

Item 6.

Ownership of More than Five Percent on Behalf of Another Person

 

See Item 4 above.

 

Item 7.

Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person

 

N/A

 

Item 8.

Identification and Classification of Members of the Group

 

See Exhibit 1 attached hereto.

 

Item 9.

Notice of Dissolution of Group

 

N/A

 

Item 10.

Certification

 

N/A

 

 

10



 

Signature

After reasonable inquiry and to the best of its knowledge and belief, each of the undersigned certifies that the information set forth in this statement is true, complete and correct.

 

 

Date: February 13, 2004

CLAYTON, DUBILIER & RICE FUND V LIMITED
PARTNERSHIP

 

 

 

By:  CD&R Associates V Limited Partnership, its general
partner

 

 

 

 

By:  CD&R Investment Associates II, Inc., its managing
general partner

 

 

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

Date: February 13, 2004

CD&R ASSOCIATES V LIMITED PARTNERSHIP

 

 

 

By:  CD&R Investment Associates II, Inc., its managing
general partner

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

Name:  Theresa A. Gore

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

Date: February 13, 2004

CD&R INVESTMENT ASSOCIATES II INC.

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

Name:  Theresa A. Gore

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

Date: February 13, 2004

CLAYTON, DUBILIER & RICE FUND VI LIMITED
PARTNERSHIP

 

 

 

By:  CD&R Associates VI Limited Partnership, its
general partner

 

11



 

 

 

 

By:  CD&R Investment Associates VI, Inc., its general
partner

 

 

 

 

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

 

 

Date: February 13, 2004

CD&R ASSOCIATES VI LIMITED PARTNERSHIP

 

 

 

 

 

By:  CD&R Investment Associates VI, Inc., Its
managing general partner

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

 

 

Date: February 13, 2004

CD&R INVESTMENT ASSOCIATES VI, INC.

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

12


EX-1 3 a04-1957_1ex1.htm EX-1

Exhibit 1

Identity of Each Member of the Group:

 

Clayton, Dubilier & Rice Fund V Limited Partnership

CD&R Associates V Limited Partnership

CD&R Investment Associates II, Inc.

Clayton, Dubilier & Rice Fund VI Limited Partnership

CD&R Associates VI Limited Partnership

CD&R Investment Associates VI, Inc.

 


EX-2 4 a04-1957_1ex2.htm EX-2

 

Exhibit 2

 

 

JOINT FILING AGREEMENT

 

The undersigned agree that the Statement on Schedule 13G to which this exhibit is attached is filed on behalf of each of them in capacities set forth below.

 

 

Date: February 13, 2004

CLAYTON, DUBILIER & RICE FUND V LIMITED
PARTNERSHIP

 

 

 

 

 

By:  CD&R Associates V Limited Partnership, its general
partner

 

 

 

 

 

 

By:  CD&R Investment Associates II, Inc., its managing
general partner

 

 

 

 

 

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

 

Name:  Theresa A. Gore

 

 

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

 

 

 

 

 

Date: February 13, 2004

CD&R ASSOCIATES V LIMITED PARTNERSHIP

 

 

 

 

 

By:  CD&R Investment Associates II, Inc., its managing
general partner

 

 

 

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

 

 

Date: February 13, 2004

CD&R INVESTMENT ASSOCIATES II INC.

 

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

 



 

Date: February 13, 2004

CLAYTON, DUBILIER & RICE FUND VI LIMITED
PARTNERSHIP

 

 

 

 

 

 

 

By:  CD&R Associates VI Limited Partnership, its
general partner

 

 

 

 

 

 

 

By:  CD&R Investment Associates VI, Inc., its general
partner

 

 

 

 

 

 

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

 

Name:  Theresa A. Gore

 

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

 

 

 

Date: February 13, 2004

CD&R ASSOCIATES VI LIMITED PARTNERSHIP

 

 

 

 

 

By:  CD&R Investment Associates VI, Inc., Its
managing general partner

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

 

 

 

 

 

 

 

Date: February 13, 2004

CD&R INVESTMENT ASSOCIATES VI, INC.

 

 

 

 

 

By:

/s/ Theresa A. Gore

 

 

 

 

Name:  Theresa A. Gore

 

 

 

Title:    Vice President and Treasurer

 

 


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