0001470254-15-000005.txt : 20150630
0001470254-15-000005.hdr.sgml : 20150630
20150630181241
ACCESSION NUMBER: 0001470254-15-000005
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20150630
FILED AS OF DATE: 20150630
DATE AS OF CHANGE: 20150630
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Unique Fabricating, Inc.
CENTRAL INDEX KEY: 0001617669
STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLE PARTS & ACCESSORIES [3714]
IRS NUMBER: 461846791
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1228
BUSINESS ADDRESS:
STREET 1: 800 STANDARD PARKWAY
CITY: AUBURN HILLS
STATE: MI
ZIP: 48326
BUSINESS PHONE: 248-853-2333
MAIL ADDRESS:
STREET 1: 800 STANDARD PARKWAY
CITY: AUBURN HILLS
STATE: MI
ZIP: 48326
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Peninsula Fund V Limited Partnership
CENTRAL INDEX KEY: 0001470254
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37480
FILM NUMBER: 15962604
BUSINESS ADDRESS:
STREET 1: 500 WOODWARD AVENUE
STREET 2: SUITE 2800
CITY: DETROIT
STATE: MI
ZIP: 48226
BUSINESS PHONE: 313-237-5100
MAIL ADDRESS:
STREET 1: 500 WOODWARD AVENUE
STREET 2: SUITE 2800
CITY: DETROIT
STATE: MI
ZIP: 48226
3
1
primary_doc.xml
PRIMARY DOCUMENT
X0206
3
2015-06-30
0
0001617669
Unique Fabricating, Inc.
UFAB
0001470254
Peninsula Fund V Limited Partnership
500 WOODWARD AVENUE
SUITE 2800
DETROIT
MI
48226
0
0
1
0
Common Stock
1415400
D
Warrant to Buy Common Stock
3.33
2013-12-18
2023-12-18
Common Stock
29232
D
Bradley J. Wyatt, Attorney-in-Fact
2015-06-30
EX-24
2
penvpoa.txt
POWER OF ATTORNEY
POWER OF ATTORNEY
Know all by these presents that the undersigned hereby
constitutes and appoints each of Bradley J. Wyatt and Richard M.
Bolton, signing singly, the undersigned's true and lawful attorney-
in-fact to:
(1) execute for and on behalf of the undersigned, in the
undersigned's capacity as a 10% shareholder of
Unique Fabricating, Inc. (the "Company"), Forms 3,
4, and 5 in accordance with Section 16(a) of the
Securities Exchange Act of 1934 and the rules
thereunder; and Form ID, adopted by the Securities
and Exchange Commission.
(2) do and perform any and all acts for and on behalf of
the undersigned which may be necessary or
desirable to complete and execute any such Form
3, 4, or 5, or Form ID, and timely file such form with
the United States Securities and Exchange
Commission and any stock exchange, stock market
or similar authority; and
(3) take any other action of any type whatsoever in
connection with the foregoing which, in the opinion
of such attorney-in-fact, may be of benefit to, in the
best interest of, or legally required by, the
undersigned, it being understood that the
documents 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 each 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, or such attorney-in-fact's substitute or substitutes, 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 attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not
assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934.
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 the undersigned's holdings of and transactions in
securities issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to the foregoing
attorneys-in-fact.
[Signature page follows]
IN WITNESS WHEREOF, the undersigned has caused this Power
of Attorney to be executed as of this 30th day of June, 2015.
PENINSULA FUND V LIMITED PARTNERSHIP
By: Peninsula Fund V Management L.L.C.
Its: General Partner
By: Peninsula Capital Partners L.L.C.
Its: Manager
By: /s/ Scott A. Reilly
Scott A. Reilly
President and Chief Investment Officer
STATE OF MICHIGAN
COUNTY OF WAYNE
On this 30th day of June, 2015, Scott A. Reilly personally appeared
before me, and acknowledged that he or she executed the
foregoing instrument for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Dan J. Scanlan, Jr.
Notary Public
/SEAL/
3