Sec Form 4 Filing - Jackowski Michael A. @ DUCK CREEK TECHNOLOGIES, INC. - 2021-02-02

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Jackowski Michael A.
2. Issuer Name and Ticker or Trading Symbol
DUCK CREEK TECHNOLOGIES, INC. [ DCT]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Executive Officer
(Last) (First) (Middle)
C/O DUCK CREEK TECHNOLOGIES, INC., 22 BOSTON WHARF ROAD
3. Date of Earliest Transaction (MM/DD/YY)
02/02/2021
(Street)
BOSTON, MA02210
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, par value $0.01 per share 02/02/2021 A 125,871 A 1,510,275 D
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)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Option $ 27 02/02/2021 A 18,262 02/02/2021 08/14/2030 Common Stock, par value $0.01 per share 18,262 ( 2 ) 164,358 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Jackowski Michael A.
C/O DUCK CREEK TECHNOLOGIES, INC.
22 BOSTON WHARF ROAD
BOSTON, MA02210
X Chief Executive Officer
Signatures
/s/ Christopher R. Stone as Attorney-in-Fact 02/24/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents vested restricted shares of Duck Creek Technologies, Inc. (the "Company") the reporting person acquired upon the satisfaction of a performance condition associated with previously awarded restricted share units in Disco Topco Holdings (Cayman) L.P. (the "Operating Partnership") that converted into unvested restricted shares in connection with the initial public offering, as described in the Registration Statement on Form S-1 (File No. 333-240050) (the "Registration Statement") of the Company pursuant to the Company's 2020 Omnibus Incentive Plan.
( 2 )Represents vested options of the Company the reporting person acquired upon the satisfaction of a performance condition associated with previously awarded options to acquire restricted share units in the Operating Partnership that converted into unvested options to acquire shares of common stock of the Company in connection with the initial public offering, as described in the Registration Statement of the Company pursuant to the Company's 2020 Omnibus Incentive Plan.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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